Same RDI after MMA surgery
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Same RDI after MMA surgery

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Posted by Marie on July 31, 2010 at 18:59:06:

Hi everybody,

As some of you may know, I had the mma surgery 7 months ago with Dr. Li. I am 31 years old, female, asian, not obese with small jaws and narrow jaw arches. He advanced. my lower jaw forward 12mm, I don’t know how far my upper jar was advanced.


My pre-surgery RDI was 14 (all hypopneas) with many flow limitations. Even though my RDI was low, I was suffering very debilitating symptoms and was almost bedridden. Dr. Li said the flow limitations were probably causing sleep disruptions as well as the hyponeas. I tried everything including two oral appliances, cpap and apap at every pressure setting – even with no leaks and full compliance I was still exhausted/sleepy. Out of desperation, I had the mma surgery and paid for it out of pocket. My first 2 sleep studies showed nothing but my 3rd one at Stanford showed OSA but at that point I was so desperate that I couldn’t wait anymore – I was ready to quit my job.

I just got my post-surgery sleep study results from Stanford which was done 2 weeks ago. It shows that I have an RDI of 14.7 but no flow limitations. I am quite surprised at this result – my RDI did not change at all! It diagnosed me with mild to moderate sleep apnea (no complex apnea). However per the report, the AASM (American Academy of Sleep Medicine) AHI is .3. From reading the report, Stanford and the AASM have different scoring critieria.

According to Stanford,

“The Stanford Hypopnea describes events lasting at least 3 breaths or greater than or equal to 10 sec. of discernable reduction in airflow as measured by the nasal cannula flow signal amplitude, independent of an associated 3% oxygen desaturation or an EEG arousal.”

According to the AASM:

“The AASM Hypopnea describes events lasting at least 3 breaths or greater than or equal to 10 sec. of 50% or more reduction in airflow as measured by the nasal cannula flow signal amplitude AND associated with a 3% oxygen desaturation or an EEG arousal.”

This is all very confusing to me. According to Stanford, I have OSA with an RDI of 14.7 but according to AASM standards, I have an AHI of only .3. I trust Stanford more because my first 2 studies done at AASM accredited clinics with (I assume) AASM scoring critieria, showed nothing but mild snoring and many unexplained arousals.

As far as mma surgery recovery goes, my jaw has healed quite nicely and my bite is perfect.

As far as sleep goes, I do feel significantly improved as my daytime sleepiness has decreased and my memory and concentration have improved BUT I am still have fatigue issues. Sometimes I wake up in the morning and can feel my heart beating quickly.

I saw Dr. Li last week and he told me to wait at least a year post-surgery for full results. I do notice that cpap is working better at a pressure setting of 10cm/11cm whereas before it did not help. I feel cured with the CPAP now which shows that I still have some physical obstructions as opposed to something else causing my fatigue. I do notice that only the full face mask works because now air just escapes out of my mouth. After a few nights on cpap, my jaw begins to hurt since the full face mask presses against my lower jaw, even when the straps are loose. I will wait until my jaw fully heals and then try cpap again. I’m also considering soft tissue surgeries such as genioglossus advancement/hyoid advancement but I have yet to discuss this with Dr. Li.

I was wondering, I have Blue Cross Blue Shield health insurance – do they recognize the Stanford RDI or AASM AHI for reimbursement purposes? As I would like to get a titration study and maybe more surgery later but I wonder which scoring method is recognized by insurance companies?

What is your guy's opinion on my next course of action? I do not want to go back to cpap but prior to mma I said that I wouldn't mind doing the mma as long as cpap works afterwards but now that I've had such good results and successful recovery I would like to try the soft tissue surgeries. I guess this is human nature to want more.

Has anyone ever been unable to use cpap after the genioglossus advancement surgery? I heard the surgery makes your chin sore and since I am only able to use the full face mask which presses against the chin I wonder if this would be a problem.

Thank you in advance for your help.

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