Isolated nasal surgery in the treatment of adult obstructive sleep apnea syndrome – Pilot study
DOI:
https://doi.org/10.34631/sporl.1064Keywords:
Nasal surgery, Obstructive sleep apneaAbstract
Objective: to evaluate the effects of isolated nasal surgery in the treatment of Obstructive Sleep Apnea Syndrome (OSAS), through the impact on the reduction of the Apnea-Hypopnea Index (AHI), the Oxygen Desaturation Index (ODI), the minimal peripheric oxygen saturation (SpO2min) and in the results of the Epworth Sleepiness Scale (ESS).
Study Design: retrospective cohort study
Material and methods: Clinical processes of patients diagnosed with OSAS who had complete clinical assessment with polysomnography, drug induced sleep endoscopy (DISE) and Computed Tomography (CT) of the paranasal sinuses and pharynx, were analyzed. Those who underwent isolated nasal surgery as a therapeutic procedure and performed a control polysomnography were selected. The following variables, before and after the intervention, were submitted to statistical analysis: AHI, ODI, SpO2min, ESS result and weight.
Results: Of the fifteen patients, mostly male (13/86.6%), there was a statistically significantimprovement of the AHI (p=0.019), ODI (p=0.008) and ESS (p=0,015) after surgery. There was no statistically significant association between SpO2min (p=0.089) or weight (p=0.862) before and after surgery.
Conclusions: Isolated nasal surgery can be effective in OSAS, in selected patients.
References
Patel SR. Obstructive sleep apnea. Ann Intern Med. 2019 Dec 3;171(11):ITC81-ITC96. doi: 10.7326/AITC201912030.
Kline LR. Clinical presentation and diagnosis of obstructive sleep apnea in adults. UpToDate. 2022. Disponível em: <https://www.uptodate.com/contents/clinical-presentation-and-diagnosis-of-obstructive-sleep-apnea-in-adults>. Acedido em 01.05.2022.
Gottlieb DJ, Punjabi NM. Diagnosis and management of obstructive sleep apnea: a review. JAMA. 2020 Apr 14;323(14):1389-1400. doi: 10.1001/jama.2020.3514.
Labarca G, Saavedra D, Dreyse J, Jorquera J, Barbe F. Efficacy of CPAP for improvements in sleepiness, cognition, mood, and quality of life in elderly patients with OSA: systematic review and meta-analysis of randomized controlled trials. Chest. 2020 Aug;158(2):751-764. doi: 10.1016/j.chest.2020.03.049.
Virk JS, Kotecha B. When continuous positive airway pressure (CPAP) fails. J Thorac Dis. 2016 Oct;8(10):E1112-E1121. doi: 10.21037/jtd.2016.09.67.
Mehrtash M, Bakker JP, Ayas N. Predictors of continuous positive airway pressure adherence in patients with obstructive sleep apnea. Lung. 2019 Apr;197(2):115-121. doi: 10.1007/s00408-018-00193-1.
Bakker JP, Weaver TE, Parthasarathy S, Aloia MS. Adherence to CPAP: what should we be aiming for, and how can we get there? Chest. 2019 Jun;155(6):1272-1287. doi: 10.1016/j.chest.2019.01.012.
Rotenberg BW, Murariu D, Pang KP. Trends in CPAP adherence over twenty years of data collection: a flattened curve. J Otolaryngol Head Neck Surg. 2016 Aug 19;45(1):43. doi: 10.1186/s40463-016-0156-0.
Veasey SC, Rosen IM. Obstructive sleep apnea in adults. N Engl J Med. 2019 Apr 11;380(15):1442-1449. doi: 10.1056/NEJMcp1816152.
Kent D, Stanley J, Aurora RN, Levine C, Gottlieb DJ, Spann MD. et al. Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2021 Dec 1;17(12):2499-2505. doi: 10.5664/jcsm.9592.
Rotenberg BW, Vicini C, Pang EB, Pang KP. Reconsidering first-line treatment for obstructive sleep apnea: a systematic review of the literature. J Otolaryngol Head Neck Surg. 2016 Apr 6;45:23. doi: 10.1186/s40463-016-0136-4.
Rotenberg BW, Theriault J, Gottesman S. Redefining the timing of surgery for obstructive sleep apnea in anatomically favorable patients. Laryngoscope. 2014 Sep;124 Suppl 4:S1-9. doi: 10.1002/lary.24720.
Weaver E, Kapur V. Surgical treatment of obstructive sleep apnea in adults. UpToDate. 2021. Disponível em: <https://www.uptodate.com/contents/surgical-treatment-of-obstructive-sleep-apnea-in-adults>. Acedido em 20.01.2022.
Wang M, Liu SY, Zhou B, Li Y, Cui S, Huang Q. Effect of nasal and sinus surgery in patients with and without obstructive sleep apnea. Acta Otolaryngol. 2019 May;139(5):467-472. doi: 10.1080/00016489.2019.1575523.
Iwata N, Nakata S, Inada H, Kimura A, Hirata M, Yasuma F. Clinical indication of nasal surgery for the CPAP intolerance in obstructive sleep apnea with nasal obstruction. Auris Nasus Larynx. 2020 Dec;47(6):1018-1022. doi: 10.1016/j.anl.2020.06.005.
Pang KP, Montevecchi F, Vicini C, Carrasco-Llatas M, Baptista PM, Olszewska E. et al. Does nasal surgery improve multilevel surgical outcome in obstructive sleep apnea: a multicenter study on 735 patients. Laryngoscope Investig Otolaryngol. 2020 Oct 8;5(6):1233-1239. doi: 10.1002/lio2.452.
Wu J, Zhao G, Li Y, Zang H, Wang T, Wang D. et al. Apnea-hypopnea index decreased significantly after nasal surgery for obstructive sleep apnea: A meta-analysis. Medicine (Baltimore). 2017 Feb;96(5):e6008. doi: 10.1097/MD.0000000000006008.
Kim ST, Choi JH, Jeon HG, Cha HE, Kim DY, Chung YS. Polysomnographic effects of nasal surgery for snoring and obstructive sleep apnea. Acta Otolaryngol. 2004 Apr;124(3):297-300. doi: 10.1080/00016480410016252.
Georgalas C. The role of the nose in snoring and obstructive sleep apnoea: an update. Eur Arch Otorhinolaryngol. 2011 Sep;268(9):1365-73. doi: 10.1007/s00405-010-1469-7.
Cai Y, Goldberg AN, Chang JL. The nose and nasal breathing in sleep apnea. Otolaryngol Clin North Am. 2020 Jun;53(3):385-395. doi: 10.1016/j.otc.2020.02.002.
Mickelson SA. Nasal surgery for obstructive sleep apnea syndrome. Otolaryngol Clin North Am. 2016 Dec;49(6):1373-1381. doi: 10.1016/j.otc.2016.07.002.
Dicus Brookes CC, Boyd SB. Controversies in Obstructive Sleep Apnea Surgery. Sleep Med Clin. 2018 Dec;13(4):559-569. doi: 10.1016/j.jsmc.2018.07.005.
Rashid NH, Zaghi S, Scapuccin M, Camacho M, Certal V, Capasso R. The value of oxygen desaturation index for diagnosing obstructive sleep apnea: a systematic review. Laryngoscope. 2021 Feb;131(2):440-447. doi: 10.1002/lary.28663.
Ogilvie RP, Patel SR. The epidemiology of sleep and obesity. Sleep Health. 2017 Oct;3(5):383-388. doi: 10.1016/j.sleh.2017.07.013.
Friedman M, Tanveri H, Lim J W, Landsberg R, Vaidyanathan K, Caldarelli D. Effect of improved nasal breathing on obstructive sleep apnea. Otolaryngol Head Neck Surg. 2000 Jan;122(1):71-4. doi: 10.1016/S0194-5998(00)70147-1.
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 Sep;153(3):326-33. doi: 10.1177/0194599815594374.
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. Jan-Feb 2011;25(1):45-9. doi: 10.2500/ajra.2011.25.3558.
Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP. et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009 Jun 15;5(3):263-76.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Portuguese Journal of Otorhinolaryngology and Head and Neck Surgery
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
