Comparative Analysis of Postoperative Outcomes in Patients Undergoing MMA with and Without DISE

Introduction: Maxillomandibular advancement (MMA) is an effective surgical treatment for obstructive sleep apnea (OSA), but the role of preoperative drug-induced sleep endoscopy (DISE) in predicting postoperative outcomes remains uncertain. This study compares postoperative apnea–hypopnea index (AHI) outcomes and surgical success rates between patients undergoing MMA alone and those undergoing MMA following DISE, after adjusting for baseline clinical characteristics.

Methods: A single-institution, retrospective cohort study was done with patients who underwent MMA for obstructive sleep apnea (OSA) between 2016-2024. The results were included and grouped by the presence of preoperative drug-induced sleep endoscopy (DISE). Outcomes included postoperative apnea-hypopnea index (AHI), change in AHI, and surgical success as defined by Sher15 and Sher20 criteria (AHI reduction ≥ 50% from baseline and AHI ≤ 15 events/hour for Sher15 or 20 events/hour for Sher20). Unadjusted comparisons used the Wilcoxon, Welch t-test, and chi-square analyses. Multivariable linear and logistic regressions adjusted for age, sex, BMI, preoperative AHI, and year of surgery.

Results: 80 patients met the inclusion criteria (26 MMA only; 54 DISE and MMA). Median postoperative AHI was 9.2 for MMA only and 11.6 for DISE and MMA (p = 0.32). Mean AHI reduction was –42.3 vs –29.7, respectively (p = 0.07). Surgical success rates were comparable between groups (Sher15: 52% vs 57%, p = 0.84; Sher20: 68% vs 74%, p = 0.77). Multivariable regression demonstrated no independent association between DISE status and postoperative AHI or surgical success.

Conclusions: Preoperative DISE was not associated with significant differences in postoperative AHI, AHI reduction, or Sher15/Sher20 success rates following MMA. Both groups demonstrated substantial improvement, suggesting that DISE may not independently influence surgical outcomes in this cohort.