Clinical Practice Guideline: Clinical Efficacy of Nasal Surgery in the Treatment of Obstructive Sleep Apnea

Park, Do Yang; Cho, Jae Hoon; Gi, Jung Yong; Choi, Ji Ho; Kim, Dong Kyu; Kim, Sang–Wook; Kim, Hyo Yeol; Park, Soo Kyung; Park, Chan Soon; Yang, Hyung Chae; Lee, Jun Young; Cho, Hyung‐Ju

doi:10.21053/ceo.2022.01361

Cited by 4 publications

(1 citation statement)

References 81 publications

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“…However, there is sparse data on if topical medications can improve daytime sleepiness or objective metrics on polysomnography. In contrast, nasal surgery has been shown to improve daytime sleepiness in OSA patients, with evidence demonstrating a significant improvement in postoperative ESS scores [26 ▪ ]. Although isolated nasal surgery alone has not been shown to correct AHI [27], multiple studies have demonstrated that nasal surgery can improve subjective measures nasal obstruction and improve CPAP use and effectiveness [28,29].…”

Section: Nasal Airwaymentioning

confidence: 99%

Obstructive sleep apnea for the rhinologist

Nogues,

Jain,

Chou

et al. 2023

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose Obstructive sleep apnea (OSA) is a ubiquitous disease defined by repetitive partial or complete cessation of airflow during sleep caused by upper airway collapse. Otolaryngologists play a crucial role in the management of OSA, which is rapidly evolving with the advent of new surgical techniques and medical devices. Here we review the medical and surgical treatment options for OSA with a focus on unique considerations for patients with OSA who undergo nasal, sinus, and skull base surgery. Recent findings Treatment of OSA includes both nonsurgical and surgical options. Positive airway pressure (PAP) therapy remains the first-line medical treatment for OSA, but alternatives such as oral appliance and positional therapy are viable alternatives. Surgical treatments include pharyngeal and tongue base surgery, hypoglossal nerve stimulation therapy, and skeletal surgery. Nasal surgery has been shown to improve sleep quality and continuous positive airway pressure (CPAP) tolerance and usage. Sinus and skull base patients with comorbid OSA have special perioperative considerations for the rhinologist to consider such as the need for overnight observation and timing of CPAP therapy resumption. Summary OSA patients present with special considerations for the rhinologist. Patients with moderate to severe OSA may benefit from overnight observation after ambulatory surgery, especially those with an elevated BMI, cardiopulmonary comorbidities, and those who are not using CPAP regularly at home. Though CPAP may be safely resumed in the perioperative setting of nasal, sinus, and skull base surgery, the exact timing depends on patient, surgeon, and systemic factors such as severity of OSA, CPAP pressures required, extent of surgery, and the postoperative monitoring setting. Lastly, nasal and sinus surgery can improve sleep quality and CPAP tolerance and compliance in patients with OSA.

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Section: Nasal Airwaymentioning

confidence: 99%

Obstructive sleep apnea for the rhinologist

Nogues,

Jain,

Chou

et al. 2023

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Quality assessment of clinical practice guidelines for adult obstructive sleep apnea: A systematic review

Xu,

Peng,

Meng

et al. 2024

Sleep Medicine

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Evaluation of sodium hyaluronate-based composite hydrogels for prevention of nasal adhesions

Padalhin,

Ryu,

Yoo

et al. 2024

Biomed. Mater.

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During the healing process after intra-nasal surgery, the growth and repair of damaged tissues can result in the development of postoperative adhesions. Various techniques have been devised to minimize the occurrence of postoperative adhesions which include insertion of stents in the middle meatus, application of removable nasal packing, and utilizing biodegradable materials with antiadhesive properties. This study assesses the efficacy of two sodium hyaluronate (SH) -based freeze-dried hydrogel composites in preventing postoperative nasal adhesions, comparing them with commonly used biodegradable materials in nasal surgery. The freeze-dried hydrogels, SH-COL1 and SH-CMC-COL1, were evaluated for their ability to reduce bleeding time, promote wound healing, and minimize fibrous tissue formation. Results showed that SH-CMC-COL1 significantly reduced bleeding time compared to both biodegradable polyurethane foam (B-PUF) and SH-COL1. Both SH-COL1 and SH-CMC-COL1 exhibited enhanced wound healing effects, as indicated by significantly greater wound size reduction after two weeks compared to the control. Histological analyses revealed significant differences in re-epithelialization and blood vessel count among all tested materials, suggesting variable initial wound tissue response. Although all treatment groups had more epithelial growth, with X-SCC having higher blood vessel count at 7 days post treatment, all treatment groups did not differ in all histomorphometric parameters by day 14. However, the long-term application of SH-COL1 demonstrated a notable advantage in reducing nasal adhesion formation compared to all other tested materials. This indicates the potential of SH-based hydrogels, particularly SH-COL1, in mitigating postoperative complications associated with nasal surgery. These findings underscore the versatility and efficacy of SH-based freeze-dried hydrogel composites for the management of short-term and long-term nasal bleeding with an anti-adhesion effect. Further research is warranted to optimize their clinical use, particularly in understanding the inflammatory factors influencing tissue adhesions and assessing material performance under conditions mimicking clinical settings. Such insights will be crucial for refining therapeutic approaches and optimizing biomaterial design, ultimately improving patient outcomes in nasal surgery.

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Clinical Practice Guideline: Clinical Efficacy of Nasal Surgery in the Treatment of Obstructive Sleep Apnea

Cited by 4 publications

References 81 publications

Obstructive sleep apnea for the rhinologist

Obstructive sleep apnea for the rhinologist

Quality assessment of clinical practice guidelines for adult obstructive sleep apnea: A systematic review

Evaluation of sodium hyaluronate-based composite hydrogels for prevention of nasal adhesions

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