Nasal surgery is a beneficial modality for the treatment of obstructive sleep apnea (OSA).
Nasal surgery can facilitate the treatment of OSA using CPAP(Continuous Positive Airway Pressure). Nasal resistance or obstruction is highly related to CPAP non-acceptance where for each 0.1 Pa/cm3/s increase in resistance the odds ratio of non-acceptance increases 1.48 fold (Sugiura 2007, level 2). Nasal surgery lowers nasal resistance and Nakata & coworkers (2005, level 3) showed that using septoplasty and inferior turbinate reduction for CPAP non-adherent patients, there was a reduction in nasal resistance from 0.57 to 0.16 Pa/cm3/s and postoperatively, all patients became CPAP adherent. Nasal surgery may lower CPAP pressures by 2-3cm H2O in level 4 studies (Friedman 2000, Zonato 2006 )
Nasal surgery may facilitate the treatment of OSA using oral appliances. Non-responders to oral appliance therapy have higher nasal resistance compared with responders (Zeng 2008, level 2). Similarly, in a study of 630 patients treated with mandibular advancement devices (Marklund 2004, level 2), women with complaints of nasal obstruction had an odds radio for successful treatment of only 0.1. Since nasal surgery lowers nasal airway resistance, oral appliance therapy may be facilitated in subjects with nasal obstruction.
Nasal surgery can improve quality of life in patients with sleep apnea in level 3 & 4 studies. With nasal surgery, the Epworth Sleepiness Scale (ESS), has been shown to decline from levels associated with excessive sleepiness (>=10) to levels consistent with normal function (Verse 2002, Nakata 2005, Li 2008). SF-36 scores of OSA patients significantly improved in the role physical, emotional, vitality, social functioning, generic health and mental health domains, following nasal surgery (Li 2008).
Nasal surgery as the sole intervention effectively treats OSA in a subset of patients. The overall success rate is about 17% for Apnea hypopnea index reduction of 50% and to less than <20/hour, as summarized in a review by Verse & coworkers (2003). This is based on case series studies cited in Verse (2003), Morinaga (2009) Series (1992), and in a randomized, placebo controlled study by Koutsourelakis (2008).
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Policy statements are approved by the American Academy of Otolaryngology—Head and Neck Surgery, Inc. or Foundation (AAO-HNS/F) Boards of Directors and are typically generated from AAO-HNS/F committees. Once approved by the Academy or Foundation Board of Directors, they become official policy statements and are added to the existing policy statement library. In no sense do they represent a standard of care. The applicability of policy statements as guidance for a procedure must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these clinical policy statements will not ensure successful treatment in every situation. As with all AAO-HNS/F guidance, this policy statement should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results.
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