Management of obstructive sleep apnea in orthodontic and maxillofacial surgical practice: An evidence-based review

• Author Details:   
• Subash Chandra Nayak
• Anshuman Mishra ^*
• Kohinoor Acharya

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Background: Obstructive sleep apnea (OSA) is a prevalent sleep-related breathing disorder with significant systemic health consequences. While continuous positive airway pressure (CPAP) remains the first-line therapy, its limitations have prompted the integration of orthodontic and maxillofacial surgical interventions into OSA management protocols.
Objective: This review aims to evaluate the evidence-based role of orthodontic and maxillofacial surgical modalities including oral appliance therapy, maxillomandibular advancement (MMA), distraction osteogenesis (DO), and adjunctive procedures in the multidisciplinary treatment of OSA.
Materials and Methods: A comprehensive review of 28 highly cited original articles, systematic reviews, and meta-analyses published between 1986 and 2024 was conducted, focusing on clinical outcomes, safety, and long-term efficacy of orthodontic and surgical interventions in managing OSA.
Results: Maxillomandibular advancement consistently demonstrated significant improvements in apnea–hypopnea index (AHI), oxygen saturation, and patient-reported outcomes across adult and pediatric populations. Distraction osteogenesis offered substantial benefits in syndromic and non-syndromic craniofacial anomalies with airway obstruction. Oral appliances, particularly mandibular advancement devices (MADs), effectively managed mild to moderate OSA, with emerging evidence supporting their adjunctive role alongside surgical interventions.
Conclusion: Orthodontic and maxillofacial surgical interventions provide effective, evidence-based alternatives or adjuncts to CPAP in appropriately selected OSA patients. Interdisciplinary treatment planning, incorporating cephalometric and airway analyses, remains essential for optimizing outcomes.