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Sleep Medicine

(1332) Maxillomandibular advancement in the GLP-1 receptor agonists era: Systematic review and meta-analysis in obese OSA

Saturday, October 17, 2026

Presenting Author(s)

Renate Ma, BS

Clinical Research Fellow
Medical University of South Carolina
Charleston, South Carolina, United States

Co-Author(s)

Kaitlyn A. Roberts, BS

Clinical Research Fellow
Department of Otolaryngolgoy - Head and Neck Surgery, Medical University of South Carolina
Oxford, Indiana, United States

Co-Author(s)

CL

Cali Loblundo, BS

Clinical Research Fellow
Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, United States
SN

Shaun A. Nguyen, MD, FAPCR

Professor and Director of Clinical Research
Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina
Charleston, South Carolina, United States

Senior Author(s)

Mohamed A. Abdelwahab, MD, PhD

Assistant Professor
Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina
Charleston, SC, United States

Introduction: Obstructive sleep apnea (OSA) is a common comorbidity among patients with obesity. Pharmacologic therapy with glucagon-like peptide-1 receptor agonists (GLP-1s) and surgical intervention with maxillomandibular advancement (MMA) are established treatment options. However, the relative efficacy of these approaches for reducing OSA severity in patients with obesity remains unclear.

Methods: A systematic review of CINAHL, Cochrane Library, PubMed, and Scopus from inception to October 2025 was conducted per PRISMA guidelines. Studies of GLP-1s or MMA for OSA in patients with obesity were included. Extracted variables were study characteristics, patient demographics, and OSA outcomes (e.g., Apnea-Hypopnea Index (AHI), Epworth Sleep Scale (ESS), Lowest Oxygen Saturation (LSAT)). Outcomes were summarized as pooled means, percent change (%), and corresponding differences (Δ) with 95% confidence intervals (CI). Risk of bias was assessed using Risk of Bias 2 (RoB2) and Joanna Briggs Institute (JBI) tools.

Results: A total of six studies of GLP-1s (n=554) and fourteen of MMA (n=143) were included, with no significant baseline differences in age, BMI, or OSA severity between cohorts. Patients undergoing MMA had a greater mean percent reduction in AHI than those of GLP-1-s (85.5% vs 37.3%; Δ: 48.2, 95% CI [12.0 - 84.4], p = 0.0091). ESS mean percent reduction was also larger with MMA (65.7% vs. 29.7%, Δ: 35.9, 95% CI [24.8 - 47.1], p < 0.0001), as was the mean percent increase in LSAT (18.9% vs. 3.2%, Δ: 15.8, 95% CI [11.4 - 20.2], p < 0.0001).

Conclusions: Both GLP-1s and MMA were associated with improvements in OSA severity, daytime sleepiness, and oxygenation, but MMA demonstrated significantly greater improvements across all outcomes. These findings suggest that MMA offers more substantial reductions in disease burden than pharmacologic weight loss alone, and highlights the need for prospective, randomized trials directly comparing GLP-1 therapy and MMA to define optimal management.