Current Knowledge/Study Rationale: Since a relatively large number of patients with severe OSA will not fully adhere to CPAP therapy—presumably leaving them at continued high risk for cardiovascular events and a diminished quality of life—it is extremely important to have alternative therapies available that can effectively treat severe OSA over a patient's lifetime. To the best of our knowledge, no studies have comprehensively and concomitantly examined the long-term effectiveness and safety of maxillomandibular advancement (MMA) as an alternative therapy to CPAP. We conducted this study to determine if MMA is a clinically effective and safe long-term treatment for OSA patients, as measured by changes in the apnea-hypopnea index (AHI), blood pressure (BP), sleepiness, and quality of life (QOL).
Study Impact: Our results show that MMA produces substantial and sustained reductions in the AHI, diastolic BP, and subjective sleepiness with concomitant improvements in QOL. Importantly, MMA has a good risk-benefit ratio, as these successful outcomes were achieved in the context of minimal long-term treatment-related adverse outcomes. The results of this study provide compelling evidence to suggest that MMA should be the alternative treatment of choice for patients with severe OSA who cannot fully adhere to CPAP.