Abstract
The aim of this study was to investigate the effects of surgical intervention for nasal pathologies on obstructive sleep apnea syndrome (OSAS) and continuous positive airway pressure (CPAP) titrations in patients with OSAS. The study was designed as a prospective case control study. Between December 2007 and June 2010, 31 patients (26 men and 5 women) who were diagnosed with OSAS with polysomnography and confirmed to have obstructive nasal pathology were enrolled in the study. The average age of the patients was 53 ± 9.6 (range 33–68 years) and the body mass index ranged from 22 to 40.6 kg/m2 with an average of 30.3 ± 4.1. The patients were evaluated with Epworth Sleepiness Scale, OSAS Complaints Questionnaire, visual analog scale, and CPAP titration before and 3 months after nasal surgery. As three patients did not attend the control polysomnography, data analysis was performed on 28 patients. Although there was a significant improvement in the nasal passage and subjective complaints, namely, snoring frequency, apnea and daytime sleepiness, the difference between preoperative and postoperative AHI values was not statistically significant. Postoperative CPAP titration results indicated a decrease both in pressures and in AHI in comparison to preoperative values. These reductions were not statistically significant, although the decrease in CPAP pressures was close to significance (p = 0.062). Nasal pathologies should be treated in all patients with OSAS, particularly those undergoing CPAP treatment. However, patients should be counseled that favorable results might not be achieved after nasal surgery.
Similar content being viewed by others
References
Young T, Evans L, Finn L, Patla M (1997) Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep 20(9):705–706
American Academy of Sleep Medicine (2005) International classification of sleep disorders: diagnostic and coding manual, 2nd edn. American Academy of Sleep Medicine, West-chester
Lugaresi E, Cirignota F, Coccanga G, Pianna C (1980) Some epidemiological data on snoring and cardiocirculatory disturbances. Sleep 3(3–4):221–224
Jennum P, Hein HO, Suadicani P, Gyntelberg F (1992) Cardiovascular risk factors in snorers. A cross-sectional study of 3,323 men aged 54 to 74 years: the Copenhagen male study. Chest 102(5):1371–1376
Palomaki H, Partinen M, Erkinjuntti T, Kaste M (1992) Snoring, sleep apnea syndrome, and stroke. Neurology 42(7):75–81
George CF, Smiley A (1999) Sleep apnea and automobile crashes. Sleep 22(6):790–795
Sullivan CE, Issa FG, Berthon-Jones M, Eves L (1981) Reversal of obstructive sleep apnea by continuous positive airway pressure applied through nares. Lancet 1(8225):862–865
Masdon J, Magnuson J, Youngblood G (2004) The effects of upper airway surgery for obstructive sleep apnea on nasal continuous positive airway settings. Laryngoscope 114(2):205–207
Verse T, Maurer J, Pirsig W (2002) Effect of nasal surgery on sleep related breathing disorders. Laryngoscope 112(1):64–68
Sires F, Pieere SS, Carrier G (1992) Effects of surgical correction of nasal obstruction in the treatment of obstructive sleep apnea. Am Rev Respir Dis. 146:1261–1265
Colman M (1986) Use of a nasal pharyngeal airway after palatopharyngoplasty in patients with obstructive sleep apnea. Laryngoscope. 96:212–213
Verse T, Pirsig W (2003) Impact of impaired nasal breathing on sleep disordered breathing. Sleep Breath 7(2):63–76
Young T, Finn L, Kim H (1997) Nasal obstruction as a risk factor for sleep disordered breathing. J Allergy Clin Immunol 99(2):757–762
Rubinstein I (1995) Nasal inflammation in patients with obstructive sleep apnea. Laryngoscope 105(2):175–177
Hudgel D, Hendricks C (1988) Palate and hypopharynx-sites of inspiratory narrowing of the upper airway during sleep. Am Rev Respir Dis 138(6):1542–1547
Olsen K, Kern E, Westbrook P (1981) Sleep and breathing disturbance secondary to nasal obstruction. Otolaryngol Head Neck Surg 89(5):804–810
Freidman M, Tanyeri H, Lim JW, Landsberg R, Vaidyanathan K, Caldarelli D (2000) Effect of improved nasal breathing on obstructive sleep apnea. Otolaryngol Head Neck Surg 122:71–74
Nakata S, Noda A, Yasuma F, Morinaga M, Sugiura M, Katayama N et al (2008) Effects of nasal surgery on sleep quality in obstructive sleep apnea with nasal obstruction. Am J Rhinol 22(1):59–63
Koutsourelakis I, Georgoulopoulos G, Perraki E, Vagiakis E, Roussos C, Zakynthinos S (2008) Randomized trial of nasal surgery for fixed nasal obstruction in obstructive sleep apnoea. Eur Resp J 31(1):110–117
Kim S, Choi J, Jeon H, Cha H, Kim D, Chung Y (2004) Polysomnographic effects of nasal surgery for snoring and obstructive sleep apnea. Acta Otolaryngol 124(3):297–300
Virkkula P, Bachour A, Hytonen M, Salmi T, Malmberg H, Hurmerinta K et al (2006) Snoring is not relieved by nasal surgery despite improvement in nasal resistance. Chest 129(1):8–87
Li HY, Lin Y, Chen NH, Lee LA, Fang TJ, Wang PC (2008) Improvement in quality of life after nasal surgery alone for patients with obstructive sleep apnea and nasal obstruction. Arch Otolaryngol Head Neck Surg 134(4):429–433
Ohki M, Usui N, Kanazawa H, Hara I, Kawano K (1996) Relationship between oral breathing and nasal obstruction in patients with obstructive sleep apnea. Acta Otolaryngol Suppl 523:228–230
Hormann K, Verse T (2010) Surgery for Sleep Disordered Breathing. Springer, Berlin
Mayer-Brix J, Becker H, Peter J (1989) Nasal high pressure ventilation in obstructive sleep apnea syndrome. Theoretical and practical otorhinolaryngologic aspects. Laryngorhinootologie 68:295–298
Dorn M, Pirsig W, Verse T (2001) Management of patients with severe obstructive sleep apnea following rhinosurgical interventions. A pilot study. HNO. 49:642–645
Nakata S, Noda A, Yagi H, Yanafi E, Mimura T, Okada T et al (2005) Nasal resistance for determinant factor of nasal surgery in CPAP failure patients with obstructive sleep apnea syndrome. Rhinology 43(4):296–299
Zonato AI, Bittencourt LR, Martinho FL, Gregorio LC, Tufik S (2006) Upper airway surgery: the effect on nasal continuous positive airway pressure titration on obstructive sleep apnea patients. Eur Arch Otorhinolaryngol 263(5):481–486
Olsen KD, Kern EB (1990) Nasal influences on snoring and obstructive sleep apnea. Mayo Clin Proc 65(8):1095–1105
Zwillich CW, Pickett C, Hanson FN, Weil JV (1981) Disturbed sleep and prolonged apnea during nasal obstruction in normal men. Am Rev Respir Dis 124(2):158–160
Fairbanks DNF (1984) Snoring: surgical vs nonsurgical management. Laryngoscope 94(9):118–119
Loth S, Petruson B, Wiren L, LW L (1999) Better quality of life when nasal breathing of snoring men is improved at night. Arch Otolaryngol Head Neck Surg 125(1):64–67
Akcam T, Friedman O, Cook T (2004) The effect on snoring of structural nasal valve dilatation with a butterfly graft. Arch Otolaryngol Head Neck Surg 130(11):1313–1318
Conflict of interest
All authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sufioğlu, M., Ozmen, O.A., Kasapoglu, F. et al. The efficacy of nasal surgery in obstructive sleep apnea syndrome: a prospective clinical study. Eur Arch Otorhinolaryngol 269, 487–494 (2012). https://doi.org/10.1007/s00405-011-1682-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-011-1682-z