Abstract
ObjectivesThis study aimed to evaluate the hypothesis that relief of nasal obstruction in subjects with obstructive sleep apnea (OSA) would lead to reduce OSA severity and to discuss the available evidence on the clinical efficacy of nasal surgery as a treatment modality for OSA.Study DesignTwenty-five subjects who had reduced patency of nasal cavity and narrowing of retroglossal or retropalatal airways were diagnosed with OSA and underwent nasal surgery, such as septoplasty or turbinoplasty to correct nasal pathologies. The effect of the surgery on nasal patency was quantified by measuring minimal cross-sectional area (MCA) using acoustic rhinometry. The watch-PAT-derived respiratory disturbance index (RDI), apnea and hypopnea index (AHI), lowest oxygen saturation, and valid sleep time were measured before and after nasal surgery.ResultsThe present study shows that the AHI and RDI decreased significantly and the lowest oxygen saturation and valid sleep time rose after nasal surgery in 25 OSA subjects. In addition, a reduction in subjective symptoms was observed in subjects and mean MCA increased after nasal surgery. Fourteen subjects were classified as responders and 11 subjects as non-responders. Responders showed considerable improvement of their subjective symptoms and the AHI and RDI were significantly lower after surgery. We found that the changes between pre- and post-operative AHI and RDI values were minimal in 11 non-responders. However, daytime somnolence and REM sleep time improved after nasal surgery in non-responders.ConclusionsOur study provides evidence that the surgical treatment of nasal pathology improves nasal airway patency and reduces OSA severity in 56% subjects. Furthermore, correction of nasal pathology appears to result in improved sleep quality in both responder and non-responders OSA subjects.
Highlights
Obstructive sleep apnea (OSA) is a common sleep disorder and is characterized by airway collapse at multiple levels of upper airway, which cause reduction or cessation of airflow
The present study shows that the apnea-hypopnea index (AHI) and respiratory disturbance index (RDI) decreased significantly and the lowest oxygen saturation and valid sleep time rose after nasal surgery in 25 OSA subjects
A reduction in subjective symptoms was observed in subjects and mean minimal cross-sectional area (MCA) increased after nasal surgery
Summary
Obstructive sleep apnea (OSA) is a common sleep disorder and is characterized by airway collapse at multiple levels of upper airway, which cause reduction or cessation of airflow. It may cause nighttime hypoxemia or vascular injury due to free oxygen radicals and even lead to cardiovascular, endocrinologic and neurocognitive diseases without proper diagnosis treatment [1,2]. Medical treatments for nasal obstruction have been studied for conditions such as snoring, upper airway resistance syndrome, and OSA with allergic rhinitis. Surgery is indicated for patients who cannot tolerate CPAP, who don’t have a considerable reduction of their AHI using CPAP alone, or who may not be able to use a CPAP machine because of their employment [13,14]
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