Introduction: In orthognathic surgery, understanding the patients motives for treatment is a key factor for postoperative patient satisfaction and treatment success. In countries/systems where orthognathic surgery is funded by public means, patients are referred mainly due to functional problems, although studies of quality of life related changes after treatment indicate that psychosocial and aesthetic reasons might be equal or more important for the patient. There is no available validated condition specific instruments in the Swedish language for quality of life evaluation of patients with dentofacial deformities. Aims/objectives: Cross cultural translation and adaptation of the English-language instrument Orthognathic Quality of Life Questionnaire (OQLQ) into Swedish. Methods: OQLQ was translated into Swedish. A total of 121 patients in four groups were recruited and the Swedish version of the OQLQ (OQLQ-S) was tested by psychometric methods. Reliability was assessed by internal consistency and test-retest reliability. Validity was evaluated by face, convergent and discriminant validity. Results/findings and conclusions: OQLQ-S is reliable and showed good construct validity and internal consistency and can be used in a Swedish speaking population as a complement to clinical variables to evaluate patients with dentofacial deformity.

When treating patients with orthognathic surgery, there might be a risk of obstructive sleep apnoea (OSA) due to soft tissue changes in the upper airways, especially in patients treated with isolated mandibular setback or mandibular setback in combination with maxillary advancement. In the present study, we assessed respiratory function during sleep with home cardiorespiratory polygraphy in 62 patients who had not been previously been diagnosed with OSA at three times: prior to orthognathic surgery for aesthetic and functional indications, and then 3 months and 1 year after surgery. We evaluated surgical displacement based on measurements in three dimensions using pre- and post-operative computed tomography. There were only minor changes in the respiratory parameters such as the apnoea-hypopnoea index (AHI), the apnoea-hypopnoea index in the supine position (AHIsup), the oxygen saturation index (ODI) and the snore index. There was no significant correlation between surgical displacement and the AHI, AHIsup and ODI. There was a weak but significant correlation between vertical displacement of the anterior mandible and the snore index. Within the limitations of the present study, the risk for iatrogenic obstruction of the upper airways seems to be low in patients without OSA treated with orthognathic surgery.

Background

Many patients have positional obstructive sleep apnoea (OSA) with an apnoea-hypopnoea index (AHI) that is two-fold higher in supine sleep than in non-supine sleep. In these patients, the proportion of time spent in supine sleep influences the overall AHI. With the example of OSA patients treated with a mandibular advancement device (MAD), the aim of this study was to test the hypothesis that between-measurement differences in the proportion of supine sleep time are a significant factor affecting changes in AHI.

Methods

One hundred sixty-five adult OSA patients treated with MAD were included in the study. Data on AHI, supine sleep time, age, sex, body mass index (BMI), Epworth Sleepiness Scale (ESS) scores, mandibular protrusion, patient-reported use, and adverse effects of the MAD were retrospectively collected from medical records or the Swedish Sleep Apnoea Register.

Results

Among included patients, 27.3% (45/165) had both positional OSA at baseline and a ≥ 50% difference in the proportions of supine sleep time between baseline and follow-up. A generalized linear model showed that changes in the proportion of supine sleep time had a statistically significant impact on the change in overall AHI from baseline to follow-up of similar size as the effect the MAD.

Conclusions

Changes in the proportion of supine sleep time are an important contributor to between -measurements changes in overall AHI in many patients treated with MAD. Positional OSA must be acknowledged not only in OSA diagnostics but also in MAD treatment follow-up.