Monitoring of Home Respiratory Polygraphy During Mandibular Distraction Osteogenesis Succeeded by LeFort I Osteotomy in Adult Patients With Obstructive Sleep Apnea

Background: Bilateral internal ramus distraction (BIRD) is now part of select protocols for treating obstructive sleep apnea (OSA). Introducing a home monitoring protocol offers a valuable alternative to overnight laboratory polysomnography (PSG). Purpose: The purpose of this study was to evaluate and compare OSA parameters obtained via home respiratory polygraphy (HRP) and hospital PSG in a cohort of patients undergoing mandibular distraction for OSA management. Study Design, Setting, Sample: Hospital Universitario La Princesa (Madrid) researchers conducted a prospective cohort study with patients diagnosed with moderate (apnea-hypopnea index (AHI) = 15 to 30) to severe (AHI>30) OSA undergoing BIRD followed by LeFort maxillary osteotomy. Exclusion criteria were as follows: severe systemic diseases, central apneas, smoking, poor dental hygiene, or prior OSA interventions. Predictor Variable: The predictor variable was PSG and HRP techniques. Main Outcome Variables: The main outcome variable comprises a collection of OSA parameters, including the AHI, oxygen desaturation index (ODI), and time spent below 90% oxygen saturation (T90). These data were measured both before and after distraction, as well as after 6 mm, 9 mm, and 12 mm of mandibular distraction. Covariates: The covariates were age, sex, cardiovascular risk parameters, and the Epworth sleepiness scale. Analyses: Pearson's correlation analyzed AHI, ODI, and T90 values from PSG and HRP. Wilcoxon Signed Rank -Sum Test compared 2 distraction stages, and the Friedman Test evaluated 3 stages (P < .05). Multiple regression analysis assessed if covariates were independent risk factors for postoperative persistent OSA. Results: The study included 32 patients (25% with moderate and 75% with severe OSA). Final AHI was 10.9 +/- 8.9 (events/hour) with HRP, compared to 15.2 +/- 13.4 with PSG (r = 0.7, P < .05). ODI was 9.0 +/- 8.1 (des/h) with HRP and 8.7 +/- 9.5 with PSG (r = 0.85, P < .05). T90 was 1.6 +/- 2.2 with HRP and 1.3 +/- 3.0 with PSG (r = 0.6, P < .05). Based on HRP data, AHI improved from D1 (34.0 +/- 19.5) to D2 (20.8 +/- 14.1) and D3 (12.5 +/- 10.4) ( P < .05). ODI decreased from D1 (26.1 +/- 19.0) to D2 (16.0 +/- 12.6) and D3 (9.4 +/- 8.8) ( P < .05). T90 reduced from D1 (8.2 +/- 12.6) to D2 (4.1 +/- 5.2) and D3 (1.9 +/- 2.8) ( P < .05). Multiple regression analysis of comorbidities produced nonsignificant results. Conclusion and Relevance: Monitoring BIRD through HRP has demonstrated efficacy in yielding results that align with PSG. (c) 2024 American Association of Oral and Maxillofacial Surgeons