Comparative evaluation of surgical treatment methods for adult patients with obstructive sleep apnea syndrome. A systematic review. Part II

Stage I operations of the Powell-Riley protocol have low efficacy (<50%) in isolated use for the treatment of moderate-to-severe obstructive sleep apnea syndrome (OSAS); therefore multilevel surgery (MLS), involving various combinations of such interventions, is becoming increasingly widespread. Orthognathic surgery with maxillomandibular advancement (MMA), a Stage II intervention in the Powell-Riley protocol, is the most effective surgical option. The lack of a comparative analysis of MLS and MMA in the domestic literature makes it advisable to study foreign experience for the implementation of optimal surgical protocols in patients with OSAS. Objective. To compare the efficacy of MLS and MMA interventions in the comprehensive treatment of patients with OSAS through an analysis of current literature. Material and methods. This study is based on an analysis of publications on MLS and MMA spanning from 2014 to 2024. OSAS was diagnosed using polysomnography and cardiorespiratory monitoring data, with treatment outcomes evaluated pre- and postoperatively over a follow-up period of >3 months. The success of surgical treatment was determined by a decrease in the apnea/hypopnea index to <20, or a reduction exceeding 50% of the baseline value. The search for publications was carried out in the PubMed, Scopus, Web of Science, Cochrane Library and PMC Russia databases with subsequent statistical analysis of the data. Results. The overall success of MLS was 60.9%, MMA — 87.5%. Conclusion. It is advisable to recommend MLS to patients at the stage of drawing up a plan for the comprehensive treatment of moderate-to-severe OSAS when prescribing CPAP (Continuous Positive Airway Pressure) therapy. If MLS is ineffective and/or there is a dentoalveolar anomaly in a patient with moderate-to-severe OSAS, it is advisable to perform MMA. MMA may be considered as an alternative to CPAP therapy and MLS in patients with moderate-to-severe OSAS.