Nasal surgery is a beneficial modality for the treatment of obstructive sleep apnea (OSA).
Nasal surgery can facilitate the treatment of OSA by improving compliance with CPAP (Continuous Positive Airway Pressure). There is significant correlation between nasal resistance or obstruction and 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). Nasal surgery lowers nasal resistance. Nakata & coworkers (Nakata et al 2008) showed that using septoplasty and inferior turbinate reduction for CPAP non-adherent patients demonstrated that 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 (Friedman 2000; Zonato 2006 ). Nasal surgery (septoplasty and turbinoplasty) led to increased CPAP use and decreased CPAP pressure (Poirrier et al, 2014).
Nasal surgery may facilitate the treatment of OSA by improving the use of oral appliances. Non-responders to oral appliance therapy have higher nasal resistance compared with responders (Zeng 2008). Similarly, in a study of 630 patients treated with mandibular advancement devices (Marklund 2004), women with complaints of nasal obstruction had an odds ratio 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. 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 (Nakata 2005; Li 2008; Park 2014). Quality of life measured by SF-36 scores of OSA patients significantly improved in the role of physical, emotional, vitality, social functioning, generic health and mental health domains, following nasal surgery (Li 2008).
Nasal surgery as the sole intervention may effectively treat OSA in a subset of patients. Nasal surgery improved nasal airway patency and reduced OSA severity in 56% of patients and led to statistically significant decreases in AHI and ESS (Park 2014; Morinaga 2009) and in a randomized, placebo controlled study by Koutsourelakis (2008).
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- Li H, Wang PC, Chen YP, Lee LA, Fang TJ, Lin HC. Critical appraisal and meta-analysis of nasal surgery for obstructive sleep apnea. Am J Rhinol Allergy. 2010 Dec 17. [Epub ahead of print] PubMed PMID: 21172121.
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