Residual POSA after maxillomandibular advancement in patients with severe OSA

In patients with severe or extreme OSA and CPAP failure, maxillomandibular advancement (MMA) can be considered. Because of its considerable morbidity, MMA is mostly reserved for severe to extreme cases, often after less aggressive surgeries have failed. The success rates of MMA are very high: between 80 and 90 %. A new finding is that MMA failure can be due to the fact that after surgery the AHI in supine sleep position remains much higher as compared to the non-supine AHI: in other words, non-positional OSA has reversed into less severe POSA. Postoperative residual POSA can be in theory a good indication for additional positional therapy. In this chapter we will discuss our theoretical considerations on this phenomenon of residual POSA after MMA surgery.