Polysomnography in the Early Consolidation Phase of Mandibular Distraction as a Tool to Identify Residual Tongue-Based Airway Obstruction and Need for Further Distraction: A Follow-Up Study

Abstract

Background: The objective of this study was to analyze and report our experience with using polysomnography (PSG) during the early consolidation phase of mandibular distraction osteogenesis (MDO) in patients with Pierre Robin Sequence and associated tongue-based airway obstruction with management decisions informed by the results. The secondary objective was to determine whether pre-operative PSG can predict which patients will have persistent obstructive sleep apnea (OSA) and require additional distraction. Methods: A single-surgeon, retrospective review was performed of all patients who underwent MDO for treatment of tongue-based airway obstruction over an 11-year period. Pre-operative and post-distraction 16-channel overnight bedside PSG was performed on all patients and scored according to the AASM Scoring Manual. Patients who demonstrated persistent OSA underwent further distraction and were reevaluated by PSG after final distraction length was achieved. Results: Pre-operative and post-distraction PSG was obtained and available for analysis in 37 patients. Apnea-Hypopnea Index (AHI) improved from 45.85 ± 34.41 to 9.73 ± 10.85 (P < .001). There was evidence for persistent, severe OSA in 14 patients (38%) and persistent, moderate OSA in 6 patients (16%) in the early consolidation phase of MDO. Nine of these patients underwent additional distraction and demonstrated symptomatic resolution and quantitative improvement in all PSG measures. The group of patients that underwent additional distraction had significantly more severe baseline OSA as defined by preoperative AHI, oxygen desaturation index (ODI), and percentage of time spent below 90% SpO₂. There was no significant difference in patient characteristics or pre-operative symptoms between the 2 groups. Conclusions: PSG can be performed at the bedside at the end of the distraction phase of MDO to assess for residual airway obstruction and inform the need for further distraction. Pre-operative PSG measures can help predict the need for further distraction and aid in operative planning and distractor placement.