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Sleep Apnea Syndromes: HELP
Articles by Leonard B. Kaban
Based on 11 articles published since 2010
(Why 11 articles?)
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Between 2010 and 2020, L. Kaban wrote the following 11 articles about Sleep Apnea Syndromes.
 
+ Citations + Abstracts
1 Review Biomechanics of the upper airway: Changing concepts in the pathogenesis of obstructive sleep apnea. 2010

Susarla, S M / Thomas, R J / Abramson, Z R / Kaban, L B. ·Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA. ssusarla1@partners.org ·Int J Oral Maxillofac Surg · Pubmed #21030210.

ABSTRACT: Obstructive sleep apnea (OSA) is a disorder characterized by repetitive, episodic collapse of the pharyngeal airway. Over the last two decades, understanding of the pathophysiology of sleep disordered breathing, which includes OSA, has improved. Once thought to be predominately related to anatomic constriction of the maxillomandibular complex, central nervous system regulation of breathing is now recognized as a significant contributor to the pathogenesis of OSA. Ventilator control, the central response to chemoreceptor phenomena, has important implications for oral and maxillofacial surgeons who treat OSA, particularly for patients who appear refractory to treatment with maxillomandibular advancement (MMA). The purpose of this article is to review the biomechanics of the upper airway as it relates to the pathophysiology of OSA, to discuss emerging concepts of ventilator control mechanisms in normal sleep versus sleep-disordered breathing and to discuss the concept of complex sleep apnea, a new category of sleep disordered breathing with both obstructive and central features.

2 Article Morbidity and Mortality Rates After Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea. 2016

Passeri, Luis A / Choi, James G / Kaban, Leonard B / Lahey, Edward T. ·Research Fellow and Visiting Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA; and Professor of Oral and Maxillofacial Surgery, Department of Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil. · Resident, Department of Oral and Maxillofacial Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA. · Walter C. Guralnick Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA. · Assistant in Oral and Maxillofacial Surgery and Instructor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA. Electronic address: elahey@post.harvard.edu. ·J Oral Maxillofac Surg · Pubmed #27181624.

ABSTRACT: PURPOSE: To compare morbidity and mortality rates in obstructive sleep apnea (OSA) versus dentofacial deformity (DFD) patients undergoing equivalent maxillofacial surgical procedures. PATIENTS AND METHODS: Patients with OSA who underwent maxillomandibular advancement with genial tubercle advancement in the Massachusetts General Hospital Department of Oral and Maxillofacial Surgery from December 2002 to June 2011 were matched to patients with DFD undergoing similar maxillofacial procedures during the same period. They were compared regarding demographic variables, medical comorbidities, perioperative management, intraoperative complications, early and late postoperative complications, and mortality rate. RESULTS: A study group of 28 patients with OSA and a control group of 26 patients with DFD were compared. The patients with OSA were older (41.9 ± 12.5 years vs 21.7 ± 8.6 years), had a higher American Society of Anesthesiologists classification (2.0 ± 0.5 vs 1.3 ± 0.6), and had a higher body mass index (29.6 ± 4.7 kg/m(2) vs 23.0 ± 3.1 kg/m(2)). They also had a greater number of medical comorbidities (2.4 ± 2.3 vs 0.7 ± 1.0). More OSA patients than DFD patients had complications (28 [100%] vs 19 [73%], P = .003), and the total number of complications in the OSA group was higher (108 vs 33, P < .001). Of the complications, 13.9% in the OSA group and 3.0% in the DFD group were classified as major. The absolute risk of a complication was 3.9 for the OSA group versus 1.3 for the DFD group. The relative risk of complications in OSA patients compared with DFD patients was 3.0. No difference in mortality rate was found. CONCLUSIONS: The patients in the OSA group were older, had more comorbidities, and ultimately had a greater number of early, late, minor, and major complications than those in the DFD group. The incidence of death in both groups was zero. Maxillomandibular advancement appears to be a safe procedure regarding mortality rate, but OSA patients should be counseled preoperatively regarding the relative increased risk of complications.

3 Article Skeletal stability of patients undergoing maxillomandibular advancement for treatment of obstructive sleep apnea. 2015

Lee, Sang Hwa / Kaban, Leonard B / Lahey, Edward T. ·Former Visiting Research Fellow, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA; Currently Associate Professor, Department of Oral and Maxillofacial Surgery, Yeouido St Mary's Hospital, The Catholic University of Korea, Seoul, Korea. · Walter C. Guralnick Professor and Chairman, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA. · Assistant in Oral and Maxillofacial Surgery and Instructor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA. Electronic address: elahey@mgh.harvard.edu. ·J Oral Maxillofac Surg · Pubmed #25622883.

ABSTRACT: PURPOSE: To determine the long-term stability of maxillomandibular advancement (MMA) in patients with obstructive sleep apnea (OSA). MATERIALS AND METHODS: This was a retrospective cohort study of patients who underwent MMA and genial tubercle advancement (GTA) for treatment of OSA. Patients were included if they 1) were older than 19 years; 2) had a confirmatory polysomnogram; 3) underwent a Le Fort I osteotomy, bilateral sagittal split osteotomies, and GTA; 4) had adequate radiographic documentation; and 5) at least 11 months of follow-up. Exclusion criteria included previous orthognathic or other maxillofacial surgery. Predictor variables were the presence of OSA treated by MMA, pre- and postoperative orthodontia or no orthodontia, length of follow-up, and magnitude of advancement. The outcome variable was the stability of MMA judged by clinical examination and cephalometric measurements. Standardized lateral cephalometric measurements were performed preoperatively (T0), immediately postoperatively (T1), and at the latest follow-up beyond 11 months (T2). Differences in cephalometric measurements were calculated between time points (T0 to T1 and T1 to T2) for the overall group and for patients who had orthodontia (group 1) and those who did not (group 2). A correlation analysis using length of follow-up and magnitude of advancement as predictor variables of stability was completed. For all analyses, a P value less than .05 was considered statistically significant. RESULTS: During the 9-year study period, 120 patients with OSA were evaluated and 112 had operative treatment; 25 patients specifically had MMA and GTA, met the inclusion criteria, and formed the study sample. The mean maxillary and mandibular advancements (T1 vs T0) were 9.48 mm (range, 1.6 to 15.2 mm) and 10.85 mm (range, 6.3 to 15.8 mm), respectively. From T1 to T2, no occlusal changes occurred. Changes in the subgroup analyses included a decrease in the angle formed by the sella, nasion, and A point (SNA) and the angle formed by the nasion and A and B points (ANB) and an increase in the angle formed by the mandibular plane (gnathion and gonion) to a line from the sella to the nasion in group 1 and a decrease in ANB in group 2. The only statistical mean difference in cephalometric measurements between groups was in the distance between the condylion and the gnathion. There was no correlation between length of follow-up (mean, 27.84 months) and changes in cephalometric measurements. CONCLUSION: Results of this study indicate that although there were changes in the SNA and ANB from T1 to T2 suggesting maxillary relapse, the mean difference was no greater than 1° and no patients developed a malocclusion; therefore, the changes were considered clinically minor. Advancement of the maxillomandibular complex by 10 mm for treatment of OSA remains stable at a mean follow-up period longer than 2 years and preoperative orthodontic treatment does not appear to influence skeletal stability.

4 Article Orthognathic surgery in patients over 40 years of age: indications and special considerations. 2014

Peacock, Zachary S / Lee, Cameron C Y / Klein, Katherine P / Kaban, Leonard B. ·Assistant Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA. Electronic address: zpeacock@partners.org. · DMD Candidate, Harvard School of Dental Medicine, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA. · Instructor in Orthodontics, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA. · Walter C. Guralnick Professor and Chairman, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA. ·J Oral Maxillofac Surg · Pubmed #24836418.

ABSTRACT: PURPOSE: To assess indications, incidence, patient experience, and outcomes of orthognathic surgery in patients over 40 years of age. PATIENTS AND METHODS: This was a retrospective cohort study of all patients who underwent orthognathic surgical procedures at Massachusetts General Hospital from 1995 to 2012. Demographic variables, including age, gender, indications, date, and type of operation, were documented. Patients were divided into 2 groups by date of operation: 1) 1995 to 2002 and 2) 2003 to 2012. The predictor variable was age (>40 vs <40 yr). Outcome variables included indications for treatment, date of operation, length of hospital stay, and removal of hardware. RESULTS: During the study period, 1,420 patients underwent 2,170 procedures; 911 patients (1,343 procedures) met the inclusion criteria. Group 1 consisted of 260 subjects (346 procedures, 35 patients ≥40 yr old, 13.5%) and group 2 consisted of 651 subjects (997 procedures, 89 patients ≥40 yr old, 13.8%). Subjects over 40 had longer hospital stays (P ≤ .0001) than those under 40. Indications for men were more frequently functional problems, whereas women sought esthetic improvements (P = .0001). Subjects over 40 were 2.51, 2.44, and 2.72 times more likely to require hardware removal 6 months (P = .0245), 12 months (P = .0073), and 24 months (P = .0003) postoperatively than those younger than 40. CONCLUSION: Motivation to undergo orthognathic surgery varies by age and gender. Older patients, particularly men, tend to seek treatment for functional rather than esthetic reasons. Patients older than 40 years had longer hospital stays and an increased rate of postoperative hardware removal.

5 Article Effects of mandibular distraction osteogenesis on three-dimensional airway anatomy in children with congenital micrognathia. 2013

Abramson, Zachary R / Susarla, Srinivas M / Lawler, Matthew E / Peacock, Zachary S / Troulis, Maria J / Kaban, Leonard B. ·Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA. ·J Oral Maxillofac Surg · Pubmed #22632931.

ABSTRACT: PURPOSE: To assess the 3-dimensional (3D) computed tomography (CT) changes in airway size and shape in children with congenital micrognathia treated by mandibular distraction osteogenesis (DO). PATIENTS AND METHODS: This was a retrospective study of patients with congenital micrognathia, treated by mandibular DO, who had pre- and postoperative 3D maxillofacial CT scans from the hard palate to the hyoid bone. Digital 3D-CT reconstructions were made before and after distraction. Demographic (age, gender, and diagnosis) and anatomic (airway size and shape) variables were recorded and analyzed. The pre-distraction measures of size and shape were compared with the post-distraction measures. P≤.05 was considered significant. RESULTS: During the study period (1999 to 2010), 17 children with congenital micrognathia underwent mandibular DO. Of these patients, 11 (3 females) met the inclusion criteria. The mean age was 6.8 years (range 1.3 to 20.6). All subjects had first and second pharyngeal arch deformities. Nine were tracheostomy dependent before distraction. Postdistraction increases in the anteroposterior diameter (153%), lateral airway diameter (70%), airway volume (76%), minimal retroglossal (162%) and retropalatal (77%), and minimal cross-sectional areas (282%) were obtained. The mean airway length decreased after distraction by 4 mm DO also affected the airway shape: the airway surface area and airway compactness increased after distraction. Six subjects were decannulated or had their tracheostomies capped. Three subjects remained tracheostomy dependent after distraction. The reasons for continued tracheostomy included copious secretions, muscle hypotonia, hypopharnygeal stenosis, and mandibular hypomobility. CONCLUSIONS: DO for congenital micrognathia increases airway size, decreases airway length, and alters the shape as measured using 3D-CT.

6 Article Upper airway length decreases after maxillomandibular advancement in patients with obstructive sleep apnea. 2011

Susarla, Srinivas M / Abramson, Zachary R / Dodson, Thomas B / Kaban, Leonard B. ·Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA 02114, USA. ssusarla1@partners.org ·J Oral Maxillofac Surg · Pubmed #21507540.

ABSTRACT: PURPOSE: Most reports on airway anatomy after maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA) have focused on changes in airway diameter, ie, posterior airway space (PAS), rather than airway length. The purpose of this study was to evaluate changes in cephalometrically measured upper airway length (UAL) after MMA. MATERIALS AND METHODS: This was a retrospective cohort study. The sample was composed of subjects who underwent MMA for OSA. The primary outcome measurement was change in UAL measured on lateral cephalograms. Predictor variables included patient demographic and cephalometric characteristics. Secondary outcome measurements were changes in sleep disturbance. Descriptive, bivariate, and regression statistics were computed. For all analyses, P ≤ .05 was considered statistically significant. RESULTS: The sample included 23 adult subjects (mean age, 39.3 ± 12.1 years; 6 women). Subjects had average maxillary and mandibular advancements of 9.8 ± 2.0 and 10.8 ± 2.2 mm, respectively. Mean pre- and postoperative UALs were 75.8 ± 7.0 and 67.0 ± 5.7 mm, respectively (P < .001). Mean pre- and postoperative respiratory disturbance indexes were 53.2 ± 22.4 and 19.0 ± 12.0 events/hour, respectively (P = .003). All patients had improvement in OSA symptoms, but 3 (13%) required continuous positive airway pressure. CONCLUSION: The results of this study suggest that UAL decreases as a result of MMA. In addition, these results support the observation that MMA is associated with objective and subjective improvements in patients with OSA.

7 Article Three-dimensional computed tomographic airway analysis of patients with obstructive sleep apnea treated by maxillomandibular advancement. 2011

Abramson, Zachary / Susarla, Srinivas M / Lawler, Matthew / Bouchard, Carl / Troulis, Maria / Kaban, Leonard B. ·Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA 02114, USA. ·J Oral Maxillofac Surg · Pubmed #21353929.

ABSTRACT: PURPOSE: To evaluate changes in airway size and shape in patients with obstructive sleep apnea (OSA) after maxillomandibular advancement (MMA) and genial tubercle advancement (GTA). MATERIALS AND METHODS: This was a retrospective cohort study, enrolling a sample of adults with polysomnography-confirmed OSA who underwent MMA + GTA. All subjects who had preoperative and postoperative 3-dimensional computed tomography (CT) scans to evaluate changes in airway size and shape after MMA + GTA were included. Preoperative and postoperative sleep- and breathing-related symptoms were recorded. Descriptive and bivariate statistics were computed. For all analyses, P < .05 was considered statistically significant. RESULTS: During the study period, 13 patients underwent MMA + GTA, of whom 11 (84.6%) met the inclusion criteria. There were 9 men and 2 women with a mean age of 39 years. The mean body mass index was 26.3; mean respiratory disturbance index (RDI), 48.8; and mean lowest oxygen saturation, 80.5%. After MMA + GTA, there were significant increases in lateral and anteroposterior airway diameters (P < .01), volume (P = .02), surface area (P < .01), and cross-sectional areas at multiple sites (P < .04). Airway length decreased (P < .01) and airway shape (P = .04) became more uniform. The mean change in RDI was -60%. CONCLUSIONS: Results of this preliminary study indicate that MMA + GTA appears to produce significant changes in airway size and shape that correlate with a decrease in RDI.

8 Article Cephalometric measurement of upper airway length correlates with the presence and severity of obstructive sleep apnea. 2010

Susarla, Srinivas M / Abramson, Zachary R / Dodson, Thomas B / Kaban, Leonard B. ·Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA 02114, USA. ssusarla1@partners.org ·J Oral Maxillofac Surg · Pubmed #20869147.

ABSTRACT: PURPOSE: The purpose of this study was to measure upper airway length (UAL) on lateral cephalograms and to assess its relationship with the presence and severity of obstructive sleep apnea (OSA). MATERIALS AND METHODS: Using a case-control study design, the investigators enrolled a sample of cases defined as adult subjects with OSA and controls who were adult patients with skeletal Class II malocclusions. The primary predictor variable was UAL. Other variables were demographic and cephalometric parameters. The respiratory disturbance index (RDI) was used to measure disease severity in cases. Bivariate analyses were computed to evaluate the associations between predictor and outcome variables. Multiple regression analyses were used to provide adjusted measures of association, controlling for the effects of confounders/effect modifiers. Diagnostic test characteristics were computed for threshold airway lengths. P ≤ .05 was considered statistically significant. RESULTS: The sample consisted of 96 cases with OSA (76 males) and 56 controls without OSA (36 males). OSA subjects were older, were predominately male, and had higher body mass indexes and longer and narrower airways (P < .05). After controlling for confounding variables, UALs ≥ 72 mm for males and ≥ 62 mm for females were significantly associated with the presence of OSA (P = .03). The sensitivity and specificity of UAL as a diagnostic test for OSA were ≥ 0.8. UAL was strongly correlated with RDI (disease severity) in males (r = 0.72, P < .01) and moderately correlated with RDI in females (r = 0.52, P < .01). CONCLUSION: Increased upper airway length was correlated with the presence and severity of OSA in this sample of adult patients.

9 Article Three-dimensional computed tomographic analysis of airway anatomy. 2010

Abramson, Zachary R / Susarla, Srinivas / Tagoni, James R / Kaban, Leonard. ·Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA. ·J Oral Maxillofac Surg · Pubmed #20116709.

ABSTRACT: PURPOSE: To test the reliability of a 3-dimensional computed tomographic (3D-CT) analysis of airway size and shape and to correlate the 3D-CT findings with lateral cephalometric measurements. MATERIALS AND METHODS: Fifteen pairs of preoperative maxillofacial 3D-CT scans and digital lateral cephalograms of patients treated for obstructive sleep apnea were used in the present study. Digital 3D-CT reconstructions were created and 12 measurements of airway size and 4 of shape were analyzed. The posterior airway space (PAS), middle airway space, and hyoid to mandibular plane distances were measured on the cephalograms. We then randomly selected 5 CT scans and 5 cephalograms which were analyzed blindly on 5 separate occasions by 2 investigators (Z.A., J.T.) to establish the intraclass correlation coefficients for inter- and intraexaminer reliability. All 15 pairs of images were used to compute the Pearson correlation coefficients to establish the relationship between the CT and cephalometric measurements. RESULTS: The intra- and interexaminer reliabilities were high for all CT (0.86 to 1.0 and 0.89 to 1.0, respectively; P < .001) and cephalometric measurements (0.84 to 1.0 and 0.91 to 0.99, respectively; P < .001). The CT measurements retroglossal anteroposterior dimension and distance between the genial tubercle and hyoid exhibited a positive correlation with the PAS (r = .60, P = 02 and r = .54, P = .04, respectively), and the lateral/anteroposterior dimension demonstrated an inverse correlation (r = -.68, P = .01) with the PAS. CONCLUSION: The results of the present study indicate that the 3D-CT and lateral cephalometric measurements we selected are reliable and reproducible. The only cephalometric measurement that exhibited any correlation with the CT parameters was PAS.

10 Article Three-dimensional computed tomographic analysis of airway anatomy in patients with obstructive sleep apnea. 2010

Abramson, Zachary / Susarla, Srinivas / August, Meredith / Troulis, Maria / Kaban, Leonard. ·Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA. ·J Oral Maxillofac Surg · Pubmed #20116708.

ABSTRACT: PURPOSE: To identify abnormalities in airway size and shape that correlate with the presence and severity of obstructive sleep apnea (OSA). MATERIALS AND METHODS: This was a retrospective case series of patients undergoing treatment of OSA who had preoperative computed tomographic (CT) scans of the upper airway available. Patients who had undergone CT scanning for nonairway pathologic features during the same period served as the controls. Digital 3D-CT reconstructions were made and 12 parameters of airway size and 4 of shape were analyzed. The posterior airway space, middle airway space, and hyoid to mandibular plane distance were measured on the lateral cephalograms of the patients with OSA. Bivariate analysis was used to identify the factors associated with the presence and severity of OSA as measured by the respiratory disturbance index (RDI). Multiple regression analysis identified the factors that correlated with the RDI. RESULTS: Of the 44 patients with OSA, 15 (10 men and 5 women) had pre- and postoperative CT scans available. In addition, 17 patients (11 men and 6 women) were used as controls. The airway length was significantly increased in the patients with OSA (P < .01). On bivariate analysis, the length, lateral/retroglossal anteroposterior dimension ratio and genial tubercle to hyoid bone distance were associated with the RDI (P < .03). On multiple regression analysis, length (P < .01) had a positive correlation and the lateral/retroglossal anteroposterior dimension ratio (P = .04) an inverse correlation with the RDI. CONCLUSIONS: The results of this study indicate that the presence of OSA is associated with an increase in airway length. Airways that were more elliptical in shape and mediolaterally oriented (greater lateral/retroglossal anteroposterior dimension ratio) had a decreased tendency toward obstruction.

11 Minor Class II Division II malocclusion does not influence upper airway length. 2011

Susarla, Srinivas M / Abramson, Zachary / Dodson, Thomas B / Kaban, Leonard B. · ·J Oral Maxillofac Surg · Pubmed #21501781.

ABSTRACT: -- No abstract --