Persistent OSA After Maxillomandibular Advancement: Insights From Drug-Induced Sleep Endoscopy.

Abstract

To examine drug-induced sleep endoscopy (DISE) findings in individuals with persistent obstructive sleep apnea (OSA) after maxillomandibular advancement (MMA). Cross-sectional. Academic medical center. DISE using propofol for unconscious sedation was performed in adult study participants with OSA after MMA and possible other procedures, defined by a postoperative apnea-hypopnea index ≥ 5 events/h. The pattern of obstruction during DISE in the supine body position was characterized using the VOTE Classification. Twenty-four study participants underwent DISE examinations. Age was 46.4 ± 10.5 years, and 12% (3/24) were female. Body mass index was 26.4 ± 4.7 kg/m². DISE examinations were performed 889 ± 1009 days after MMA. The post-MMA apnea-hypopnea index was 18.2 ± 11.3 events/h. During DISE, most study participants demonstrated tongue-related obstruction, with a substantial minority showing velum- and epiglottis-related obstruction. Oropharyngeal lateral wall-related obstruction was less common. Compared to a larger cohort (n = 810) with no previous pharyngeal OSA surgery undergoing DISE, velum- and oropharyngeal lateral wall-related obstruction were less common, and epiglottis-related obstruction was more common. Among individuals with OSA following MMA, upper airway obstruction occurs due to multiple potential anatomic structures. Tongue-related obstruction is common, and epiglottis-related obstruction is more common than in those without previous pharyngeal OSA surgery.