Effectiveness of Maxillo-Mandibular Advancement on Obstructive Sleep Apnea—A Systematic Review and Meta-Analysis

The review was performed to evaluate effect of maxillo-mandibular advancements (MMA) on patients with obstructive sleep apnea (OSA) for long term and subjective outcomes. Review was adhered to PRISMA guidelines 2020. Articles screening was done independently by two authors. Quality assessment was done through Newcastle Ottawa scale (NOS) and Cochrane risk of bias (ROB)-2 tool. Standardized mean difference (SMD) was used as summary statistic measure employing random effect model through Review manager (RevMan) version 5.3. Twelve studies (5 retrospective studies, 4 prospective studies and 3 clinical studies) were included for qualitative synthesis and ten studies for meta-analysis. Included studies evaluated subjective parameters like apnea index (AI), Apnea-Hypopnea Index (AHI), Desaturation Index (DI), Epworth Sleepiness Scale (ESS), Hypopnea index (HI), Respiratory Disturbance Index (RDI), Total Sleep Time (TST) and airway morphological parameters like Posterior Airway Space (PAS). Meta-analysis was conducted on AHI, mean SpO2, RDI, TST, ESS and airway morphological parameters like Al and PAS which indicated that post treatment witgh MMA had improved the overall quality of life (P<0.05). Included studies had presence of low to moderate risk of bias. No asymmetry was seen on funnel plot signifying absence of publication bias in meta-analysis. It was found that MMA is an ideal, reliable and most effective treatment modality for patients with OSA improving their overall quality of life with minimal complications with high success and cure rate.