Tolerance of Continuous Positive Airway Pressure After Sinonasal Surgery

Abstract

Objectives/Hypothesis For patients with obstructive sleep apnea (OSA) undergoing sinonasal surgery, there is a lack of consensus on the risk and appropriate postoperative use of continuous positive airway pressure (CPAP). The aim of this study was to assess the tolerability of restarting CPAP on postoperative day one. Study Design Prospective cohort study. Methods A prospective study on patients with OSA on CPAP who required a septoplasty/turbinectomy and/or functional endoscopic sinus surgery (FESS) was performed. Data from the memory card of a patient's CPAP machine and subjective information were obtained on the day of surgery and at scheduled follow‐up visits. All subjects were instructed to restart CPAP on the first postoperative night. Results A total of 14 patients were analyzed; nine underwent FESS and five had a septoplasty/turbinectomy. There were no postoperative complications encountered. The only significant change in the first postoperative week was a reduction in the percentage of nights used over 4 hours (P < .05). By the third postoperative visit, average 22‐item Sino‐Nasal Outcome Test, Nasal Obstruction Symptom Evaluation, and CPAP tolerance scores improved from preoperative values. CPAP pressures, residual apnea–hypopnea index, and number of hours and mean percentage of nights used remained stable throughout the study period. Conclusions Both quality‐of‐life and CPAP outcomes improved or remained the same when restarting CPAP immediately postoperatively. Combined with a lack of significant complications, this study suggests that CPAP is well‐tolerated when restarted the day after a septoplasty/turbinectomy or FESS. Level of Evidence 4 Laryngoscope, 131:E1013–E1018, 2021

The Effect of Pharyngeal Surgery on Positive Airway Pressure Therapy in Obstructive Sleep Apnea: A Meta-Analysis

“…After screening for relevance, 19 studies that investigated PAP therapy data, such as optimal pressure levels and/or usage time before and after surgery, were retrieved for further review [ 14 , 15 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ]. We excluded eight studies evaluating the effect of nasal surgery alone on PAP therapy [ 14 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. Two other studies were excluded due to the lack of data required for meta-analysis [ 15 , 18 ].…”

“…Some clinical studies have reported that surgical management influenced PAP therapy such as optimal levels and the duration of use [ 14 , 15 ]. Two recent meta-analyses demonstrated that surgical modifications of the upper airway were associated with decreases in optimal PAP levels and improvement in PAP adherence [ 16 , 17 ].…”

Independent Role of Nasal Congestion in Positive Airway Pressure Compliance for OSA Treatment

“…28 Management of nasal obstruction (humidification, nasal decongestants, steroids, and nasal surgery), while not significantly improving OSA severity, has the potential to improve PAP compliance in terms of duration of use at night and daily usage rate. [29][30][31][32][33] In this study, a separate analysis of patients with rhinopathy suggested that nasal treatment was associated with PAP compliance. Further studies are needed to confirm this.…”

Considerations for Functional Nasal Surgery in the Obstructive Sleep Apnea Population

“…These included severity of a patient's OSA, type of CPAP mask used, and surgical maneuvers performed (most notably tip work and osteotomies) 42 . A small study by Reilly et al demonstrated safety of restarting CPAP within 24 hours after septoplasty 43 . The decision to restart CPAP therapy should be individualized to the patient.…”

“…42 A small study by Reilly et al demonstrated safety of restarting CPAP within 24 hours after septoplasty. 43 The decision to restart CPAP therapy should be individualized to the patient. Factors to consider include severity of OSA, other comorbidities, and surgical maneuvers performed.…”