Improved Quality of Life After Mandibular Advancement by Bilateral Internal Ramus Distraction

Background: Obstructive Sleep Apnea (OSA) is a significant health issue due to noncompliance with continuous positive airway pressure treatment. Therefore, evaluating alternative treatments is crucial. Purpose: Analyze the impact of maxillomandibular advancement using bilateral internal ramus distraction (BIRD) on quality of life (QOL) in OSA patients.Study design, setting, and sample: A prospective cohort study was conducted at the Oral and Maxillofacial Surgery Department of the University Hospital "La Princesa." The study included patients with moderate to severe OSA who were treated with the BIRD approach.Predictor variable: Changes in measured variables were analyzed at three time points: before surgery (T1), after mandibular advancement (T2), and after maxillary advancement (T3).Main outcome variable(s): QOL changes measured by Quebec Sleep Questionnaire and the Epworth Sleepiness Scale. Secondary outcomes included: apnea-hypopnea index (AHI), oxygen desaturation index, and percentage of time with saturation below 90%.Covariates: Age, sex, continuous positive airway pressure treatment, cephalometric variables and cardiovascular risk parameters were considered.Analyses: Statistical analysis employed the Friedman test and c2 test, with a significance level of P #.05. Results: The study included 32 patients (22% with moderate OSA, 78% with severe OSA). Epworth Sleepiness Scale scores significantly decreased between T1 (13.4 +/- 4.4) and T2 (5.8 +/- 3.6) and T3 (1.9 +/- 1.8) (P < .001). QOL improvements were observed in all domains: daytime sleepiness T1 (3.0 +/- 1.3) T2 (5.4 +/- 1.4) T3 (6.3 +/- 1.0); diurnal symptoms T1 (2.5 +/- 1.4) T2 (5.2 +/- 1.3) T3 (6.2 +/- 1.1); nocturnal symptoms T1 (2.5 +/- 1.1) T2 (5.6 +/- 1.1) T3 (6.5 +/- 0.8); emotions T1 (2.6 +/- 1.6) T2 (5.3 +/- 1.4) T3 (6.5 +/- 0.9); and social interaction T1 (2.5 +/- 1.6) T2 (5.4 +/- 1.6) T3 (6.3 +/- 1.2) (P < .001). AHI decreased between T1 (47.9 +/- 23.1) and T2 (14.4 +/- 14.3) and T3 (4.7 +/- 5.6) h-1 (P < .001), with a final cure rate of 81.2% (defined as final AHI<5 h-1). Oxygen desaturation index and per-centage of time with saturation below 90% also showed significant reductions (P < .001).Conclusions and Relevance: BIRD approach for OSA demonstrated a high cure rate and significant QOL improvements. It shows promise as an effective surgical option. Further research and long-term follow-up are needed.(c) 2023 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 81:1215-1226, 2023