Hyoid Advancement in Females with OSA: Comparison of Two Techniques

Abstract

Objectives:

1) Describe the effectiveness of hyomandibular advancement performed alone versus hyomandibular advancement along with other pharyngeal procedures versus hyoid advancement to the thyroid cartilage (hyo-thyroid advancement) along with other pharyngeal procedures, in adult females with obstructive sleep apnea hypopnea syndrome (OSAHS).

Methods:

Retrospective case series, 2001-2011. Setting: Private practice. Subjects: 48 females with OSAHS: Hyomandibular advancement performed alone (N=12, age 51.8+7.2, body mass index [BMI] 27.8 kg/m2), Hyo-mandibular advancement along with ancillary procedures (N=23, age 50.8+11.3, BMI 32.9 kg/m2), and hyothyroid advancement along with ancillary procedures (N=13, mean age 49.7+12.4, BMI 29.4 kg/m2.

Results:

Polysomnography: Respiratory disturbance index (RDI), Apnea hypopnea index (AHI), Lowest oxygen saturation (LSAT), Epworth Sleepiness Score (ESS). Hyo-mandibular advancement alone had the lowest success rate [RDI fell: 32.5/hr to 28.0/hr (14.2% reduction), AHI fell: 30.8/hr to 23.4/hr (24.0% reduction), LSAT improved: 84.2% to 83.5%, overall success rate 36.4%]. Hyo-thyroid advancement along with ancillary procedures had an intermediate success rate [RDI fell: 27.6/hr to 21.8/hr (21.0% reduction), AHI fell: 26.3/hr to 21.6/hr (18.3% reduction), LSAT improved: 85.8% to 87.3%, overall success rate 58.3%]. Hyo-mandibular advancement along with ancillary procedures had the highest success rate [RDI fell: 26.5/hr to 13.7/hr (48.3% reduction), AHI fell: 25.5/hr to 12.6/hr (50.6% reduction), LSAT improved: 81.8% to 87.8%, overall success rate 61.1%]. BMI was unchanged. ESS scores improved in all groups.

Conclusions:

Hyomandibular advancement, coupled with other pharyngeal procedures, is more effective than hyothyroid advancement coupled with other pharyngeal procedures and more effective than hyomandibular advancment performed alone.