Nasal Surgery May Improve Upper Airway Collapse in Patients With Obstructive Sleep Apnea: A Drug-Induced Sleep Endoscopy Study

Bosco, Gabriela; Pérez-Martín, Nuria; Morato, Marta; Racionero, Miguel A.; Plaza, Guillermo

doi:10.1097/scs.0000000000005865

Cited by 7 publications

(10 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Six studies were excluded because the outcome parameters did not report the AHI or a home sleep test with a type 3 or 4 sleep study was used to diagnose OSA. A total of 21 studies met our inclusion criteria and were included in the final analysis [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. One randomized controlled trial, 1 nonrandomized controlled trial, 15 prospective studies and 4 retrospective studies were included.…”

Section: Resultsmentioning

confidence: 99%

“…The overall AHI was not significantly different after nasal surgery in twelve studies [ 15 , 16 , 17 , 18 , 21 , 22 , 23 , 24 , 25 , 28 , 29 , 30 ]. In one study, the AHI only significantly decreased in the mild OSA group, defined as AHI between 5 and 15 events/h [ 14 ].…”

Section: Resultsmentioning

confidence: 99%

“…Table 2 shows the exact results per study. Three studies were not included in the meta-analysis for change in AHI because no standard deviation of outcome was provided [ 15 , 20 , 30 ]. Wu et al only provided the AHI for different subgroups; therefore, the subgroups were separately analyzed [ 14 ].…”

Section: Resultsmentioning

confidence: 99%

“…The only randomized controlled trial excluded patients with CPAP therapy during the course of the study [ 25 ]. Three studies specifically evaluated the effect of nasal surgery in patients with CPAP intolerance [ 22 , 28 , 30 ]. In these studies, almost all patients tolerated CPAP postoperatively.…”

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

The Role of Isolated Nasal Surgery in Obstructive Sleep Apnea Therapy—A Systematic Review

Schoustra

Maanen

Haan³

et al. 2022

Brain Sciences

View full text Add to dashboard Cite

Nasal obstruction is believed to play a significant role in the pathophysiology and management of obstructive sleep apnea (OSA). However, controversy remains about the ability of isolated nasal surgery to improve OSA. The objective of this systematic review is to give an updated overview of the literature on whether isolated nasal surgery can improve OSA subjectively (Epworth Sleepiness Scale (ESS)) and/or objectively (polysomnography (PSG)). Methods: A systematic review was performed searching the electronic databases PubMed, Embase.com (accessed on 20 June 2022）Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials (CENTRAL) up to 20 June 2022. Eligible studies were reviewed for methodological quality using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results: Twenty-one studies met the inclusion criteria. The majority of the included studies reported no significant reduction in the apnea–hypopnea index (AHI) after isolated nasal surgery in patients with OSA. The meta-analysis suggests that the AHI slightly decreases after nasal surgery. The ESS was significantly lower after nasal surgery in eighteen studies. Conclusion: Based on the present analysis of objective outcomes, isolated nasal surgery did not improve the AHI significantly in the majority of the studies. The meta-analysis suggests a slight decrease in AHI after nasal surgery, but this reduction is not clinically relevant in terms of treatment success. Isolated nasal surgery should therefore not be recommended as a first-line treatment for OSA. Because of high study heterogeneity, these results should be interpreted with caution. Isolated nasal surgery can possibly improve OSA subjectively. Perhaps only OSA patients with complaints of nasal obstruction or OSA patients experiencing difficulty with continuous positive airway pressure (CPAP) compliance would benefit from isolated nasal surgery.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

The Role of Isolated Nasal Surgery in Obstructive Sleep Apnea Therapy—A Systematic Review

Schoustra

Maanen

Haan³

et al. 2022

Brain Sciences

View full text Add to dashboard Cite

show abstract

“…However, when patients have nasal respiratory failure, nasal surgery is usually performed first, since the hypopharyngeal collapse can improve. 19 The aim of this study is to evaluate the correlation of retrolingual obstruction determined by DISE through the VOTE and NOHL classifications, and the 1 observed during awake endoscopy through Friedman staging, MM and LTH in patients with OSA.…”

mentioning

confidence: 99%

Drug Induced Sleep Endoscopy Versus Awake Endoscopy in Retrolingual Obstruction Assessment in Obstructive Sleep Apnea Patients: A Comparative Study

Pérez-Martín¹,

Bosco²,

Navarro³

et al. 2021

Journal of Craniofacial Surgery

Self Cite

View full text Add to dashboard Cite

: The aim of this study is to evaluate the correlation of retrolingual obstruction determined by drug induced sleep endoscopy (DISE) and awake endoscopy evaluation of Muller maneuver (MM) and lingual tonsil hypertrophy (LTH) in patients with obstructive sleep apnea. A prospective cohort of 100 patients with obstructive sleep apnea who underwent DISE was assessed. The inclusion criteria were age between 18 and 70 years, and apnea-hypopnea index higher than 5. Friedman staging, LTH and MM were determined by awake endoscopy, as other physical findings. The authors evaluated the correlation of retrolingual obstruction determined by DISE using velum oropharynx tongue, epiglottis (VOTE) and nose, oropharynx, hypopharynx, larynx (NOHL) classification. When retrolingual MM was assessed, significant changes between awake and DISE were observed (P = 0.000). Conversely, Friedman stage had no significant changes to DISE retrolingual findings (P = 0.868). Analyzing LTH and DISE retrolingual findings according to NOHL and VOTE, if a cutoff value was established at 50%, DISE findings differ from awake: NOHL (P<0.001) and VOTE (P = 0.004). Nevertheless, if a restrictive cutoff at 75% was attached, DISE findings were similar to awake: NOHL (P = 0.124) and VOTE (P = 0.123). This study demonstrates that awake endoscopy determining LTH and Friedman stage is a mild predictor of collapse at retrolingual level, showing significant correlation to DISE only when severe retrolingual collapse is present. Our findings suggest that in-office awake endoscopy may have certain predictive value to select surgical patients.

show abstract

International Consensus Statement on Obstructive Sleep Apnea

Chang

Goldberg

Alt

et al. 2023

Int Forum Allergy Rhinol

118

View full text Add to dashboard Cite

Background: Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). Methods: Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidencebased review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. Results: The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. Conclusion:This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.

show abstract

Nasal Surgery May Improve Upper Airway Collapse in Patients With Obstructive Sleep Apnea: A Drug-Induced Sleep Endoscopy Study

Cited by 7 publications

References 21 publications

The Role of Isolated Nasal Surgery in Obstructive Sleep Apnea Therapy—A Systematic Review

The Role of Isolated Nasal Surgery in Obstructive Sleep Apnea Therapy—A Systematic Review

Drug Induced Sleep Endoscopy Versus Awake Endoscopy in Retrolingual Obstruction Assessment in Obstructive Sleep Apnea Patients: A Comparative Study

International Consensus Statement on Obstructive Sleep Apnea

Contact Info

Product

Resources

About