Does nasal surgery alone have a consistent effect on the apnea-hypopnea index in OSA patients? Most of the studies reported "NO" but some recent studies reported "YES". Are there any concensus in this important issue?
I also found nasal surgery along may change AHI level and patient's snoring index and clinical symptoms. As my point, a lot of patient complaint nasal obstruction with caudel deviation, but the traditional SMP do not currect this area. I performed ten case of open functional rhinoplasty to adjust the caudel deviation and I found very good result but long term follow up is needed.
Hello Dr. Tsai,
No
Because UARS cases have normal AHI and Oxygen Desat.
Nasal surgery can improve UARS but a lot of time can not improve AHI because of the level of obstruction is found at the retro palatal and retro lingual areas of the pharyngeal airway
Steven Hou says HI to you Dr Tsai.
You are very welcome Dr. Tsai.
Steven Hou and I are always grateful for your valuable help and encouragement.
Steven and Viet,
Dr. Viet Nghiem,
You are very welcome. It's really my pleasure and honor to have a professional discussion with you and Steven. Thank you.
Article Critical Appraisal and Meta-Analysis of Nasal Surgery for Ob...
This meta-analyses (authored by Prof. Li et al.) showed that nasal surgery cannot reduce AHI.
The meta-analyses showed that isolated nasal surgery for patients with nasal obstruction and obstructive sleep apnea improved some sleep parameters, as shown by significant improvements in ESS and RDI, but had no significant improvements on AHI.
On the contrary, this study reported AHI decreased significantly after nasal surgery for obstructive sleep apnea.
Till this moment, it is a controversial and interesting issue in OSA field.
It rarely makes a big difference in the AHI. I have seen a few cases over the course of the last 20 years that have had a significant impact. Usually, they are patients with snoring and UAR (upper airway resistance) where the change in flow reduces turbulence. After a couple of weeks, the edema in the oropharynx reduced and the apnea was improved. Most of the time it doesn't make much difference.
Dr. Louis Tartaglia,
Thank you for the highly professional comments.
I recall a case of a patient having nasal surgery for treating sleep apnea having failed to have an effect on AHI; then going on for a trial of CPAP, where the CPAP trail then also failed to produce any effect on the AHI.
It is strange that CPAP wouldn't control the apnea. Did you mean that the patient didn't tolerate the CPAP or that the pressures used did not control the apnea?
Is this caused by the poor CPAP compliance or other factors (air leak...etc)?
Nasal Surgery Is useful for improvement the cpap, and the use of complementary the airway gym , the app in smartphone
dr Connors‘s studies shows good result after months post Nasal surgery
Our review study also supported that nasal surgery improves snoring, daytime sleepiness, quality of life, and the use of CPAP or mandibular advancement device.
With regard to Louis Tartaglia query on why the CPAP was not effective after oral nasal surgery, this was a single case observation and the patient would invariable open his mouth with application of nocturnal CPAP. It is not unusual when applying CPAP to an awake person for the mouth to open and thus the applied air escapes via the open mouth. It was thought that the surgery disrupted the normal upper airway reflexes.
Article How to manage continuous positive airway pressure (CPAP) fai...
I am pleased to share our latest study corresponded by Prof. Hsueh-Yu Li.
Nasal surgery might be of help for mild OSAS, however, for moderate and severe OSAS, it has no therapeutic benefit but it may improve CPAP usage especially for patients with some nasal deformity
Dr. Ken Luco,
Thank you so much for sharing this precious experience with us.
Nasal obstruction alone can be a major factor in the development of OSA but there are many other contributary factors which may be involved in OSA causation and development. There is varying induction of secondary changes in the upper aerodigestive tract (UADT) as the condition progresses. Thus OSA has a heterogeneous causation and polymorphic expressivity. Unfortunately even if the primary cause is pure nasal obstruction and even if it is perfectly corrected surgically, it is not certain that the induced secondary UADT changes reverse to their premorbid state. Hence the conflicting clinical research findings. Precision audit of a large population might allow the identification of important prognostic and predictive factors.
Dr. Michael John Rogers,
Thank you for the excellent comments. Your insights really teach us a lot. Thank you.
Looking forward to maintaining academic interaction and discussion with you. Thank you.
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