Patient-Reported Outcomes With Focus on Health-Related Quality of Life in Patients With Obstructive Sleep Apnea Treated With Maxillomandibular Advancement Surgery: A Systematic Review and Meta-Analysis.

Objective: Maxillomandibular advancement (MMA) surgery for obstructive sleep apnea (OSA) has shown to be effective according to objective measures; however, patient-reported outcome measures (PROMs), especially health-related quality of life (HRQoL), are also crucial but have not been systematically assessed in relation to MMA surgery for OSA yet. Therefore, this study aims to conduct a systematic review on the effect of MMA surgery on PROMs focusing on HRQoL in patients with OSA.

Methods: A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines with a literature search performed in PubMed and Medline to identify relevant studies from database inception to May 2024 evaluating PROMs focusing on HRQoL in adult OSA patients treated with MMA surgery. The primary variables are the PROMs outcomes. Screening and eligibility assessments were carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis framework, and study quality was evaluated using the ROBINS-I tool. The data extraction for the meta-analysis included PROMs outcomes and was carried out in SPSS using a fixed-effects model to report effect sizes as mean differences.

Results: Thirty-three studies were screened of which 12 were included in this systematic review encompassing 317 patients. The studies reported PROMs in a heterogeneous manner, but MMA consistently showed an improvement postoperatively in mean differences. In the most used PROMs instruments MMA surgery was associated with a 5.35-point improvement in the Epworth Sleepiness Scale (95% CI -6.57 to -4.14; Z = -8.62; P < .001), a 3.96-point improvement on the Functional Outcomes of Sleep Questionnaire (95% CI 3.11, 4.80; Z = 11.60; P < .001) and an improvement in all domains of the Short Form 36 Health Survey.

Conclusions: MMA surgery for patients with OSA shows significant improvements in PROMs related to quality of life. The PROMs are positive, demonstrating satisfaction across various domains. This indicates that MMA surgery is well received by patients and results in clinically meaningful improvements in PROMs related to HRQoL.