Fig. 4

Scores of the same four questionnaires illustrated in Fig. 1: Insomnia Severity Index, Body Sensations Questionnaire, Fatigue Severity Scale, and Epworth Sleepiness Scale, evaluating the severity of insomnia, somatic arousal, fatigue, and sleepiness, respectively. These questionnaires were completed by patient 2 during his evaluation and treatment. The x-axis of each graph provides the duration, in months, of our interaction with the patient, and the y-axis provides the entire score range for each questionnaire. The date of the surgical procedure is indicated by a marker on the top gridline of each graph. Because patient 2 experienced bipolar disorder, a depression scale, the nine-item Patient Health Questionnaire, is illustrated at the bottom of the figure. The figure indicates a high but somewhat variable level of insomnia severity, somatic arousal, fatigue/sleepiness, and depressed affect for slightly more than 1 year prior to maxillomandibular advancement, with a prompt and persistent decrease in the severity of all symptoms postoperatively. The slight increase in the patient’s stress level (Body Sensations Questionnaire) and fatigue (around month 24) coincides with his relocation to the southwestern United States. The last set of scores was obtained after the relocation was complete