“Silent” Sleep Apnea in Dentofacial Deformities and Prevalence of Daytime Sleepiness After Orthognathic and Intranasal Surgery

• Main Authors: Adachie, A. (Author), Choi, E. (Author), Posnick, J.C (Author), Singh, N. (Author)
• Format: Article
• Language: English
• Published: W.B. Saunders 2018
• Subjects: adolescent; Adolescent; adult; Adult; age; Article; body mass; breathing disorder; chronic obstructive nasal breathing; cohort analysis; consultation; daytime somnolence; dentofacial deformity; disease severity; Disorders of Excessive Somnolence; Epworth sleepiness scale; female; Female; human; Humans; major clinical study; male; Male; mandibular advancement; middle aged; Middle Aged; morbid obesity; Nasal Surgical Procedures; nose surgery; obesity; orthognathic surgery; Orthognathic Surgical Procedures; outcome assessment; pathology; postoperative period; prevalence; Prevalence; Retrospective Studies; retrospective study; Sleep Apnea, Obstructive; sleep disordered breathing; Sleepiness; somnolence; underweight; young adult; Young Adult
• Online Access: View Fulltext in Publisher

 Purpose: The purposes of this study were to determine the occurrence of undiagnosed “silent” obstructive sleep apnea (OSA) in dentofacial deformity (DFD) patients at initial surgical presentation and to report on the level of daytime sleepiness in DFD patients with OSA and chronic obstructive nasal breathing (CONB) after undergoing bimaxillary, chin, and intranasal surgery. Materials and Methods: A retrospective cohort study of patients with a bimaxillary DFD and CONB was implemented. Patients were divided into those with no OSA (group I) and those with OSA (group II). Group II was further subdivided into patients referred with polysomnogram (PSG)–confirmed OSA (group IIa) and those with a diagnosis of OSA only after surgical consultation, airway evaluation, and a positive PSG (group IIb). Group II patients were analyzed at a minimum of 1 year after surgery (range, 1 to 10 years) for daytime sleepiness with the Epworth Sleepiness Scale. Patients with postoperative excessive daytime sleepiness were assessed for risk factors and continued need for OSA treatment. Patients in group II were studied to determine which DFD patterns were most associated with OSA. We compared the prevalence of OSA between our study population and the general population. Results: Two hundred sixty-two patients met the inclusion criteria. Of these, 23% (60 of 262) had PSG-confirmed OSA (group II). This rate was much higher than that found in the general population. Of the patients, 7% (19 of 262) were known to have OSA at initial surgical consultation (group IIa). An additional 16% (41 of 262) were later confirmed by PSG to have OSA (group IIb). Patients with primary mandibular deficiency and short face DFDs were most likely to have OSA (P <.001 and P =.001, respectively). In group II, 91% (55 of 60) rated their daytime sleepiness as “not sleepy” at a minimum of 1 year after surgery. A significant association was found between group II patients with postoperative excessive daytime sleepiness (“sleepy” or “very sleepy”) and a preoperative body mass index category of overweight (P =.026). Conclusions: Our study found silent OSA to be frequent in the DFD population. The prevalence of OSA in DFD patients exceeded that estimated in the general population, with retrusive jaw patterns most affected. In DFD patients also presenting with OSA and CONB, we confirmed low levels of daytime sleepiness long-term after simultaneous bimaxillary orthognathic, chin, and intranasal surgery. © 2017 American Association of Oral and Maxillofacial Surgeons