阻塞性睡眠呼吸暂停上颌下颌前移术后的全身结局：系统综述与荟萃分析
Systemic outcomes following maxillomandibular advancement for obstructive sleep apnea: systematic review and meta-analysis.
文献信息
| PMID | 42888121 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | C Holmes |
| 作者单位 | Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: cpholmes@student.ubc.ca. |
| 期刊 | International journal of oral and maxillofacial surgery |
| SCI 分区 | Q2 |
| IF | 2.7 |
| 研究类型 | 综述 Meta · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景： 阻塞性睡眠呼吸暂停（OSA）是一种常见的睡眠障碍，与全身合并症风险升高相关。上颌下颌前移术（MMA）可减轻上气道阻塞并改善睡眠参数，但其全身健康获益仍较少被充分描述。本系统综述与荟萃分析旨在综合MMA对OSA患者全身健康结局影响的证据。方法：在PubMed、Embase、Cochrane CENTRAL、Scopus和Web of Science中进行了从建库至2026年5月20日的全面文献检索。纳入标准包括报告MMA治疗OSA后全身健康结局的原始研究（病例系列、队列研究、试验）。两名评价者独立筛选并提取数据。使用NIH质量评估工具评估偏倚风险。结果：七项研究（271例患者）符合纳入标准，平均随访时间从5.2个月至6.6年不等。所有研究均报告术后呼吸暂停低通气指数显著降低。纳入荟萃分析的四项研究显示血压具有统计学显著降低：收缩压，平均差-8.6 mmHg（95%置信区间-14.2至-3.0）；舒张压，平均差-5.3 mmHg（95%置信区间-8.5至-2.0）。结论：MMA治疗OSA不仅改善气道通畅性和睡眠指标，还与持久的全身健康获益相关，包括血压降低。有限证据还提示神经认知结局可能改善。尽管证据提示积极影响，仍需采用严格结局测量（例如动态血压监测）的高质量随机对照试验，以充分阐明上颌下颌前移术持久的全身效应。
英文摘要
Obstructive sleep apnea (OSA) is a common sleep disorder associated with an elevated risk of systemic comorbidities. Maxillomandibular advancement (MMA) surgery can reduce upper airway obstruction and improve sleep parameters, but its systemic health benefits remain less well characterized. This systematic review and meta-analysis was performed to synthesize evidence on the systemic health outcomes associated with MMA in patients with OSA. A comprehensive literature search was conducted in PubMed, Embase, Cochrane CENTRAL, Scopus, and Web of Science from inception through May 20, 2026. Inclusion criteria encompassed original research studies (case series, cohort studies, trials) reporting systemic health outcomes after MMA for OSA. Two reviewers independently screened and extracted data. Risk of bias was assessed using an NIH quality assessment tool. Seven studies (271 patients), with mean follow-up ranging from 5.2 months to 6.6 years, met the inclusion criteria . All studies reported significant reductions in apnea-hypopnea index postoperatively. Four studies included in a meta-analysis demonstrated statistically significant reductions in blood pressure: systolic, mean difference -8.6 mmHg (95% confidence interval -14.2 to -3.0); diastolic, mean difference -5.3 mmHg (95% confidence interval -8.5 to -2.0). MMA for OSA not only improves airway patency and sleep metrics, but is also associated with enduring systemic health benefits, including a blood pressure reduction. Limited evidence also suggests potential improvements in neurocognitive outcomes. Although the evidence suggests a positive impact, further high-quality randomized controlled trials employing rigorous outcome measures (e.g., ambulatory blood pressure monitoring) are needed to fully delineate the persistent systemic effects of maxillomandibular advancement.