Do Age and Body Mass Index Affect Pharyngeal Airway Changes in Subjects Undergoing Maxillomandibular Advancement Surgery for Obstructive Sleep Apnea?

BACKGROUND

Maxillomandibular advancement (MMA) surgery leads to multilevel enlargement of the upper airway in the treatment of obstructive sleep apnea (OSA). However, the influence of age and body mass index (BMI) on airway changes is not well-established.

PURPOSE: The purpose of this study was to measure the association of age and BMI on changes in upper airway dimensions after MMA surgery.

STUDY DESIGN, SETTING, SAMPLE: This is a retrospective cohort study conducted at the University of Michigan in subjects with OSA who underwent MMA surgery between 2013 and 2020. Patients were excluded if they were under 18, had predominant central sleep apnea, or lacked sufficient follow-up data.

PREDICTOR VARIABLES: Age and BMI.

MAIN OUTCOME VARIABLE(S): The main outcome variables were change in airway volume (posterior nasal spine-C3), minimum cross-sectional area, and posterior airway space from cone-beam computed tomography scans obtained 1 month before surgery and 6 weeks after surgery.

COVARIATES: Sex, the amount of skeletal advancement achieved at ANPerp and BNPerp, and change in BMI were covariates.

ANALYSES: Linear regression models were utilized to assess the relationship between predictor and outcome variables. Statistical significance was set at P < .05.

RESULTS

The sample was composed of 34 subjects with a mean age of 47.4 (13.0) years (range: 18-69) and 30 (88%) were male. On multivariate regression analysis, ANperp change (P = .003) was statistically significantly associated with increasing airway volume. While age and BMI were not associated with airway volume or cross-sectional area , lower preoperative BMI (P = .04) was statistically significant associated with greater increases in posterior airway space at A-point.

CONCLUSIONS AND RELEVANCE: MMA surgery is an effective modality to expand the upper pharyngeal airway in most individuals with OSA, regardless of age. In addition, lower preoperative BMI and the magnitude of maxillary advancement play a significant role in airway changes.