Evidence-Based Medicine: The Role of Nasal Surgery in Treatment of Obstructive Sleep Apnea

Abstract

Nasal surgery performed for the management of obstructive sleep apnea includes septoplasty with and without inferior turbinate reduction and functional rhinoplasty. There is controversy over the effectiveness of these techniques in terms of their ability to decrease apnea-hypopnea index. However, it is fairly accepted that nasal surgery can improve sleep-related quality of life measures. This review focuses on the recently published evidence surrounding the role of nasal surgery in obstructive sleep apnea. Findings suggest that functional rhinoplasty may improve apnea–hypopnea index (AHI) in patients with mild OSA. The effect of septoplasty on AHI is less consistent. Further studies are needed to better clarify the role for both septoplasty and functional rhinoplasty in the OSA treatment algorithm.

Keywords

functional rhinoplasty - septoplasty - nasal surgery - obstructive sleep - apnea

Publikationsverlauf

Accepted Manuscript online:
09. Februar 2023

Artikel online veröffentlicht:
16. März 2023

• References

• 1 Senaratna CV, Perret JL, Lodge CJ. et al. Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev 2017; 34: 70-81
• 2 Lebret M, Arnol N, Martinot JB. et al. Nasal obstruction symptom evaluation score to guide mask selection in CPAP-treated obstructive sleep apnea. Otolaryngol Head Neck Surg 2018; 159 (03) 590-592
• 3 Sawyer AM, Gooneratne NS, Marcus CL, Ofer D, Richards KC, Weaver TE. A systematic review of CPAP adherence across age groups: clinical and empiric insights for developing CPAP adherence interventions. Sleep Med Rev 2011; 15 (06) 343-356
• 4 Fitzpatrick MF, McLean H, Urton AM, Tan A, O'Donnell D, Driver HS. Effect of nasal or oral breathing route on upper airway resistance during sleep. Eur Respir J 2003; 22 (05) 827-832
• 5 Friedman M, Maley A, Kelley K. et al. Impact of nasal obstruction on obstructive sleep apnea. Otolaryngol Head Neck Surg 2011; 144 (06) 1000-1004
• 6 Garcia GJM, Hariri BM, Patel RG, Rhee JS. The relationship between nasal resistance to airflow and the airspace minimal cross-sectional area. J Biomech 2016; 49 (09) 1670-1678
• 7 Leitzen KP, Brietzke SE, Lindsay RW. Correlation between nasal anatomy and objective obstructive sleep apnea severity. Otolaryngol Head Neck Surg 2014; 150 (02) 325-331
• 8 Schwartz AR, Smith PL, Wise RA, Gold AR, Permutt S. Induction of upper airway occlusion in sleeping individuals with subatmospheric nasal pressure. J Appl Physiol 1988; 64 (02) 535-542
• 9 Smith PL, Wise RA, Gold AR, Schwartz AR, Permutt S. Upper airway pressure-flow relationships in obstructive sleep apnea. J Appl Physiol 1988; 64 (02) 789-795
• 10 Morinaga M, Nakata S, Yasuma F. et al. Pharyngeal morphology: a determinant of successful nasal surgery for sleep apnea. Laryngoscope 2009; 119 (05) 1011-1016
• 11 Nakata S, Noda A, Yagi H. et al. Nasal resistance for determinant factor of nasal surgery in CPAP failure patients with obstructive sleep apnea syndrome. Rhinology 2005; 43 (04) 296-299
• 12 Poirier J, George C, Rotenberg B. The effect of nasal surgery on nasal continuous positive airway pressure compliance. Laryngoscope 2014; 124 (01) 317-319
• 13 Bosco G, Pérez-Martín N, Morato M, Racionero MA, Plaza G. Nasal surgery may improve upper airway collapse in patients with obstructive sleep apnea: a drug-induced sleep endoscopy study. J Craniofac Surg 2020; 31 (01) 68-71
• 14 Moxness MH, Nordgård S. An observational cohort study of the effects of septoplasty with or without inferior turbinate reduction in patients with obstructive sleep apnea. BMC Ear Nose Throat Disord 2014; 14: 11
• 15 Rotenberg BW, Theriault J, Gottesman S. Redefining the timing of surgery for obstructive sleep apnea in anatomically favorable patients. Laryngoscope 2014; 124 (Suppl (Suppl. 04) S1-S9
• 16 Kim SD, Jung DW, Lee JW, Park JH, Mun SJ, Cho KS. Relationship between allergic rhinitis and nasal surgery success in patients with obstructive sleep apnea. Am J Otolaryngol 2021; 42 (06) 103079
• 17 Kempfle JS, BuSaba NY, Dobrowski JM, Westover MB, Bianchi MT. A cost-effectiveness analysis of nasal surgery to increase continuous positive airway pressure adherence in sleep apnea patients with nasal obstruction. Laryngoscope 2017; 127 (04) 977-983
• 18 Yamasaki A, Levesque PA, Lindsay RW. Improvement in snoring-related quality-of-life outcomes after functional nasal surgery. Facial Plast Surg Aesthet Med 2020; 22 (01) 25-35
• 19 Hismi A, Yu P, Locascio J, Levesque PA, Lindsay RW. The impact of nasal obstruction and functional septorhinoplasty on sleep quality. Facial Plast Surg Aesthet Med 2020; 22 (06) 412-419
• 20 Shuaib SW, Undavia S, Lin J, Johnson Jr CM, Stupak HD. Can functional septorhinoplasty independently treat obstructive sleep apnea?. Plast Reconstr Surg 2015; 135 (06) 1554-1565
• 21 Wu J, He S, Li Y. et al. Evaluation of the clinical efficacy of nasal surgery in the treatment of obstructive sleep apnoea. Am J Otolaryngol 2022; 43 (01) 103158
• 22 Bican A, Kahraman A, Bora I, Kahveci R, Hakyemez B. What is the efficacy of nasal surgery in patients with obstructive sleep apnea syndrome?. J Craniofac Surg 2010; 21 (06) 1801-1806
• 23 Ishii L, Roxbury C, Godoy A, Ishman S, Ishii M. Does nasal surgery improve OSA in patients with nasal obstruction and OSA? A meta-analysis. Otolaryngol Head Neck Surg 2015; 153 (03) 326-333
• 24 Li HY, 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 2011; 25 (01) 45-49
• 25 Camacho M, Riaz M, Capasso R. et al. The effect of nasal surgery on continuous positive airway pressure device use and therapeutic treatment pressures: a systematic review and meta-analysis. Sleep 2015; 38 (02) 279-286
• 26 Wu J, Zhao G, Li Y. et al. Apnea-hypopnea index decreased significantly after nasal surgery for obstructive sleep apnea: a meta-analysis. Medicine (Baltimore) 2017; 96 (05) e6008