Classification of phenotype in adults An 2020
- Obesity type
- 50%
- Moderate OSA, Obese – BMI 25+, no skeletal discrepancy, no soft tissue abnormality
- Treatment: Weight loss, sleep hygiene
- Skeletal type
- 33%
- Moderate OSA, severe skeletal 2, high angle, narrow pharyngeal space
- Treatment: Craniofacial modification, MAS or surgery
- Complex
- 16%
- Severe OSA, combining features of 1 and 2
- Treatment: Craniofacial modification, MAS or surgery
Cause of OSA
- Anatomical factors
- Poor response of upper airway muscles
- Low arousal threshold to airway
- Unstable ventilation control
Respiratory physician for 2-4
Mandibular advancement splint
- Enlarge upper airway
- Prevent from collapse
- Can produce occlusal changes
- TMJ should be healthy
- Patient non-compliance: year 1 25%, year 5 63% Soose 2017
CPAP Vs MAS
- CPAP more effective at reducing AHI scores Cammaroto 2017
Orthognathic surgery
- Posterior impaction alone does not trigger OSA
- Posterior impaction and maxillary set back can trigger OSA
- Maxillary-mandibular counter clockwise rotation increased airway space
RME and SARPE Systematic RV Adbulatif 2016
- RME: Improvement of 60% AHI
- SARPE: improvement of 77%
- MARPE (miniscrew assisted expansion) can be used for nasopharyngeal obstruction
Seung proposed a segmental MMA for protrusive maxillary cases
- Extraction of 4s at the time of surgery
- Advancement of posterior segment
- Maintain anterior segment in AP position
- BSSO advancement
