This study assessed changes in sleep-related symptoms and polysomnographic parameters after nasal surgery for nasal obstruction in obstructive sleep apnea (OSA) adults in Taiwan.
Methods
A total of 66 patients with OSA and chronic nasal obstruction were recruited (surgical, n = 44; control, n = 22). Nasal surgery alone was the treatment in surgical patients. Outcomes were measured in a Snore Outcome Survey (SOS), Epworth Sleepiness Scale (ESS), rhinomanometry, and polysomnographic parameters at baseline and again after 3 months.
Results
Significantly improved nasal resistance as measured by the SOS and ESS were found only in the surgical group (all, p < 0.001). Both groups revealed insignificant changes in polysomnographic parameters. The patients with lower body weight index, less daytime sleepiness, and lower tongue position had a better success rate than the others (50% versus 3%; p < 0.001).
Conclusion
Although nasal surgery relieved snoring and daytime sleepiness, it had variable effects on polysomnographic parameters.
McNicholasW.T., TarloS., ColeP.Obstructive apneas during sleep in patients with seasonal allergic rhinitis.Am Rev Res Dis126: 625–628, 1982.
2.
DeeganP.C., and McNicholasW.T.Predictive value of clinical features of the obstructive sleep apnea syndrome.Eur Respir J9: 117–124, 1996.
3.
VerseT., and PirsigW.Impact of impaired nasal breathing on sleep-disordered breathing.Sleep Breath7: 63–76, 2003.
4.
McLanH.A., UrtonA.M., DriverH.S.Effect of treating severe nasal obstruction on the severity of obstructive sleep apnea.Eur Respir J25: 521–527, 2005.
5.
WoodheadC.J., and AllenM.B.Nasal surgery for snoring.Clin Otolaryngol19: 41–44, 1994.
6.
LiH.Y., LeeL.A., WangP.C.Nasal surgery for snoring in patients with obstructive sleep apnea.Laryngoscope118: 354–359, 2008.
7.
VirkkulaP., BachourA., HytönenM.Snoring is not relieved by nasal surgery despite improvement in nasal resistance.Chest129: 81–87, 2006.
8.
VerseT., MaurerJ.T., and PirsigW.Effect of nasal surgery on sleep-related breathing disorders.Laryngoscope112: 64–68, 2002.
9.
CaldarelliD.D., CartwrightR.D., and LilieJ.K.Obstructive sleep apnea: Variations in surgical management.Laryngoscope95: 1070–1073, 1985.
10.
HormannK., and VerseT.Nasal surgery.In Surgery for Sleep Disordered Breathing.Berlin, Heidelberg, New York: Springer, 13–17, 2005.
11.
GliklichR.E., and WangP.C.Validation of the Snore Outcomes Survey for patients with sleep-disordered breathing.Arch Otolaryngol Head Neck Surg128: 819–824, 2002.
12.
ChenN.H., LiH.Y., GliklichR.E.Validation assessment of the Chinese version of the Snore Outcome Survey.Qual Life Res11: 601–607, 2002.
13.
JohnsM.W.A new method for measuring daytime sleepiness: The Epworth Sleepiness Scale.Sleep14: 540–545, 1991.
14.
ChenN.H., JohnsM.W., LiH.Y.Validation of a Chinese version of the Epworth Sleepiness Scale.Qual Life Res11: 817–821, 2002.
15.
American Academy of Sleep Medicine. Sleep related breathing disorders in adults: Recommendations for syndrome definition and measurement techniques in clinical research.Sleep22: 667–689, 1999.
16.
LiH.Y., WangP.C., HsuC.Y.Nasal resistance in patients with obstructive sleep apnea.ORL J Otorhinolaryngol Relat Spec67: 70–74, 2005.
17.
FriedmanM., IbrahimH., and JosephN.Staging of obstructive sleep apnea/hypopnea syndrome: A guide to appropriate treatment.Laryngoscope114: 454–459, 2004.
18.
SherA.E., SchechtmanK.B., and PiccirilloJ.F.The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome.Sleep19: 156–177, 1996.
19.
NakataS., NodaA., YasumaF.Effect of nasal surgery on sleep quality in obstructive sleep apnea syndrome with nasal obstruction.Am J Rhinol22: 56–63, 2008.
20.
LiH.Y., LinY., ChenN.H.Improvement in quality of life after nasal surgery alone for patients with obstructive sleep apnea and nasal obstruction.Arch Otolaryngol Head Neck Surg134: 429–433, 2008.
21.
FriedmanM., TanyeriH., LimJ.W.Effect of impaired nasal breathing on obstructive sleep apnea.Otolaryngol Head Neck Surg122: 71–74, 2000.
22.
SeriesF., St. PierreS, and CarrierG.Effect of surgical correction of nasal obstruction in the treatment of obstructive sleep apnea.Am Rev Respir Dis146: 1262–1265, 1992.
23.
VirkkulaP., HytonenM., BachourA.Smoking and improvement after nasal surgery in snoring men.Am J Rhinol21: 169–173, 2007.
24.
RubinA.H., EliascharI., JoachimZ.Effect of nasal surgery and tonsillectomy on sleep apnea.Bull Eur Physiopathol Respir19: 612–615, 1983.
25.
KoutsourelakisI., GeorgoulopoulosG., PerrakiE.Randomised trial of nasal surgery for fixed nasal obstruction in obstructive sleep apnea.Eur Respir J31: 110–117, 2008.
26.
WeaverE.M., WoodsonB.T., and StewardD.L.Polysomnography indexes are discordant with quality of life, symptoms, and reaction times in sleep apnea patients.Otolaryngol Head Neck Surg132: 255–262, 2005.
27.
KemppainenT., RuoppiP., SeppaJ.Effect of weight reduction on rhinometric measurements in overweight patients with obstructive sleep apnea.Am J Rhinol22: 410–415, 2008.
28.
BiermannE.Nasal CPAP therapy in obstructive sleep apnea syndrome: Does functional rhinosurgery improve compliance [in German]?Somnologie5: 59–64, 2001.
29.
LiH.Y., EnglemanH., HsuC.Y.Acoustic reflection for nasal airway measurement in patients with obstructive sleep apnea/hypopnea syndrome.Sleep28: 1554–1559, 2005.
30.
ZengB., NgA.T., QianJ.Influence of nasal resistance on oral appliance treatment outcome in obstructive sleep apnea.Sleep31: 543–547, 2008.
