American Journal of Otolaryngology - Head and Neck Medicine and Surgery
Volume 31, Issue 1 , Pages 14-20, January 2010

Surgery vs ventilation in adult severe obstructive sleep apnea syndrome☆

  • Claudio Vicini, MD

      Affiliations

    • ENT & Oral Surgery Unit, Ospedale Morgagni Pietrantoni, Forlì, Italy
    • ,
  • Iacopo Dallan, MD

      Affiliations

    • Second ENT Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
    • Corresponding Author InformationCorresponding author. Second ENT Unit, Azienda Ospedaliero-Universitaria Pisana, U.O. ORL 2, Via Savi 10, 56126 Pisa, Italy. Tel.: +39 050 993284; fax: +39 050 992629.
    • ,
  • Aldo Campanini, MD

      Affiliations

    • ENT & Oral Surgery Unit, Ospedale Morgagni Pietrantoni, Forlì, Italy
    • ,
  • Andrea De Vito, MD

      Affiliations

    • ENT & Oral Surgery Unit, Ospedale Morgagni Pietrantoni, Forlì, Italy
    • ,
  • Francesca Barbanti, MD

      Affiliations

    • ENT & Oral Surgery Unit, Ospedale Morgagni Pietrantoni, Forlì, Italy
    • ,
  • Gianluca Giorgiomarrano, MD

      Affiliations

    • ENT & Oral Surgery Unit, Ospedale Morgagni Pietrantoni, Forlì, Italy
    • ,
  • Marcello Bosi, MD

      Affiliations

    • Sleep Centre, Pneumologic Unit, Ospedale Morgagni Pietrantoni, Forlì, Italy
    • ,
  • Giuseppe Plazzi, MD

      Affiliations

    • Sleep Centre, Neurological Clinic, University of Bologna, Bologna, Italy
    • ,
  • Federica Provini, MD

      Affiliations

    • Sleep Centre, Neurological Clinic, University of Bologna, Bologna, Italy
    • ,
  • Elio Lugaresi, MD

      Affiliations

    • Sleep Centre, Neurological Clinic, University of Bologna, Bologna, Italy

Received 12 May 2008 published online 09 March 2009.

Abstract 

Background and purpose

Management of severe obstructive sleep apnea-hypopnea syndrome (OSAHS) is challenging and needs multidisciplinary cooperation. Ventilation is considered the gold standard of treatment in severe OSAHS. The aim of the study was to compare the therapeutical efficacy of a type of surgery (maxillomandibular advancement [MMA]) vs a ventilatory treatment modality (autotitrating positive airway pressure [APAP]).

Materials and methods

At the ENT Department of Forlì Hospital (University of Pavia), in strict cooperation with the Sleep Lab of the University of Bologna, a prospective randomized controlled trial was designed and performed. After fully informing them, 50 consecutive patients who have severe OSAHS were enrolled and randomized into a conservative (APAP) or surgical (MMA) section. Demographic, biometric, polysomnogram (PSG) and Epworth Sleepiness Scale profiles of the 2 groups were statistically not significantly different.

Results

One year after surgery or continuous APAP treatment, both groups showed a remarkable improvement of mean Apnea-Hypopnea Index (AHI) and Epworth Sleepiness Scale levels; the degree of improvement was not statistically different.

Conclusions

Given the relatively small sample of subjects studied and the relatively brief follow-up, MMA proved to be a valuable alternative therapeutical tool in our adult and severe OSAHS patient group, with a success rate not inferior to APAP.

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☆ All the authors certify that they have no potential conflicts of interest with any entity mentioned in the manuscript and that they receive no financial support for this work.

PII: S0196-0709(08)00180-4

doi:10.1016/j.amjoto.2008.09.002

American Journal of Otolaryngology - Head and Neck Medicine and Surgery
Volume 31, Issue 1 , Pages 14-20, January 2010

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