The Incidence of Obstructive Sleep Apnea in Patients with Dento-Skeletal Malformation

Abstract: Purpose: The aim of this article is to analyze the incidence of undiagnosed obstructive sleep\r\napnea (OSA) in patients affected by dento-skeletal malformation. We also evaluated the patterns\r\nmost affected by the condition and calculated the post surgical changes. Methods: We conducted a\r\nretrospective cohort study on 71 patients including 35 men and 36 women. The patients studied were\r\naffected by dento-skeletal class II and III malformations and underwent bimaxillary orthognathic\r\nsurgery in all cases. Patients were evaluated with polysomnography before surgery and at least\r\n6 months after surgery to assess any improvement or worsening of the apnea hypopnea index (AHI)\r\nindex. Regarding AHI evaluation criteria, an AHI > 5 was considered indicative of OSA, 4 < AHI < 5\r\nwas considered borderline and AHI < 4 was considered indicative of non-OSA. We also considered\r\ndemographic variables like age at the time of intervention and gender, and anatomical variables\r\nlike the pattern of the dento-skeletal deformity and the presence or absence of maxillary hypoplasia.\r\nQualitative variables were described as absolute and relative frequencies, while quantitative variables\r\nwere summarized as mean and standard deviation. To quantitatively express the relationship between\r\ntwo variables, the correlation coefficient was calculated. The covariance array was used to evaluate\r\nmultiple correlations. Results: Our study shows that there is a significant percentage (33%) of patients\r\nwho undergo orthognathic surgery with an AHI > 5 and also a percentage of patients (11%) who can\r\nbe considered to be “borderline.” It emerges that the pattern most at risk is the one characterized\r\nby retruded maxilla and patients with dento-skeletal class II. Considering the post surgical period,\r\nthe statistical analysis shows that after surgery, only 8% of malformed patients present an AHI > 5,\r\ncompared to the 20.5% described in the Italian population. Conclusions: In patients who receive\r\northognathic surgery, the presence of obstructive sleep apnea is significantly higher than in the\r\ngeneral population. When planning the surgical correction of a dento-skeletal malformation, the\r\nsurgeon must aim not only for the esthetics results, but also for proper stomatognathic and respiratory\r\nfunction; this cannot be achieved without taking polysomnography information into account.