Pharyngeal morphology: A determinant of successful nasal surgery for sleep apnea

Abstract

Among sleep apnea patients suffering from nasal obstruction, nasal surgery is effective in those with a high-positioned soft palate and/or a wide retroglossal space.

Critical Appraisal and Meta-Analysis of Nasal Surgery for Obstructive Sleep Apnea

“…Li et al 3 reported that OSA patients with lower Friedman tongue position had a better success rate than the others. Morinaga et al 5 also reported that the postoperative reduction of AHI tended to be lower in those with an elevated modified Mallampati score and a narrow retroglossal space. From these findings, it can be inferred that pharyngeal obstruction in light of tongue position and related retroglossal airspace may influence the effect of nasal surgery for OSA.…”

“…[6][7][8]12,15 Rhinomanometry data were reported by 10 (76.9%) articles. [3][4][5][6][8][9][10][11][12]14 Table 1 indicates that a total of 10 (76.9%) articles used subjective symptoms as outcomes end points, 3,4,[6][7][8][9][10][11][12]14 including the Snore Outcome survey (SOS) with Sleep/Bed Partner survey (SBPS; three articles, 23.1%), 3,7,9 visual analog scale (VAS) for snoring (four articles, 30.8%), 6,7,9,10 snore-related questionnaires (two articles, 15.4%), 7,9 and the Epworth Sleepiness Scale (ESS; 9 articles, 69.2%). 3,4,6-8,10-12,14…”

“…11,12 Grading system for oropharynx were used by three (23.1%) of the studies (Table 2). 3,5,9 Outcomes of Nasal Surgery Of the 13 articles, only 9 studies provided preoperative and postoperative mean AHI Ϯ SD. The weighted mean AHI Ϯ SD of these studies decreased from 35.2 Ϯ 22.6 events/hour to 33.5 Ϯ 23.8 events/ hour after nasal surgery with an overall value of p ϭ 0.69.…”

“…[3][4][5][6][7][8][10][11][12][13][14][15] AHI is the most commonly used outcome measure (11,84.6%), [3][4][5][6][7][8][11][12][13][14][15] followed by lowest arterial saturated oxygenation (5 articles, 38.5%). [6][7][8]12,15 Rhinomanometry data were reported by 10 (76.9%) articles.…”

Nose and Sleep Breathing Disorders

“…These studies confi rmed that current nose surgery improves subjectively the snoring, the daytime sleepiness and the quality of life but failed to improve objective PSG data. Absence of pharyngeal obstruction could predict the success of nose surgery (Morinaga et al 2009 ). Conversely, increased nasal resistance could predict the failure of CPAP therapy (Nakata et al 2005 ).…”