Maxillomandibular Volume Influences the Relationship between Weight Loss and Improvement in Obstructive Sleep Apnea

Sep 10, 2015Sleep

Jaw Size Affects How Weight Loss Improves Obstructive Sleep Apnea

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Abstract

Fifty-two obese men with moderate-severe obstructive sleep apnea experienced a 34.1% reduction in apnea-hypopnea index after a 6-month weight loss program.

Participants lost an average of 7.4% of their body weight during the study.
A modest prediction of apnea-hypopnea index change was found based on body mass index reduction.
Maxillomandibular volume was identified as a moderating factor in the relationship between weight loss and improvement in obstructive sleep apnea.
A strong correlation between weight loss and obstructive sleep apnea improvement was observed only in participants with small maxillomandibular volume.
No significant relationship was detected in participants with large maxillomandibular volume.

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STUDY OBJECTIVES: Obesity is the major risk factor for OSA; however, weight loss reduces OSA to a variable extent. We aimed to assess whether size of the maxillomandibular skeletal enclosure influences the relationship between weight loss and OSA reduction.

METHODS: Obese males (≥ 30 kg/m2) with moderate-severe OSA (AHI > 15/h) participating in a 6-mo open-label weight loss program had craniofacial computed tomography (CT) scans before and after weight loss. CT scans were analysed using three-dimensional cephalometry. Maxillomandibular volume was calculated from skeletal landmarks on the mandible (condyle, gonion, menton) and maxilla (anterior nasal spine). Multiple regression analysis was used to test for moderating effects of maxillomandibular volume on relationship between changes in weight and apnea-hypopnea index (AHI).

RESULTS: Fifty-two men (age 44.3 ± 8.8 y, AHI 42.9 ± 21.3 events/h, body mass index [BMI] 34.0 ± 2.7 kg/m2) had 7.4 ± 4.1% weight loss and 34.1 ± 32.4% AHI reduction at 6 months. BMI reduction modestly predicted AHI change (r2 = 0.17, P = 0.002). The interaction term of maxillomandibular volume and BMI change was a predictor of OSA improvement (P = 0.03), indicating maxillomandibular volume moderates this relationship. Subgroup analyses of patients by small, medium, and large maxillomandibular volume showed a strong correlation between weight loss and OSA improvement only in the small volume group (r = 0.654, P = 0.004). There was no relationship evident in those with large maxillomandibular volume (r = 0.05, P = 0.9).

CONCLUSION: Maxillomandibular volume influences the relationship between weight loss and OSA improvement with an effect on AHI more evident in those with a smaller craniofacial skeleton.

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Maxillomandibular Volume Influences the Relationship between Weight Loss and Improvement in Obstructive Sleep Apnea

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