Skip to main content Accessibility help
×
×
Home

Rhinological interventions for obstructive sleep apnoea – a systematic review and descriptive meta-analysis

  • S Sharma (a1), J C R Wormald (a2) (a3), J M Fishman (a4) (a5), P Andrews (a4) (a5) and B T Kotecha (a4)...
Abstract
Objectives

Obstructive sleep apnoea is a common chronic sleep disorder characterised by collapse of the upper airway during sleep. The nasal airway forms a significant part of the upper airway and any obstruction is thought to have an impact on obstructive sleep apnoea. A systematic review was performed to determine the role of rhinological surgical interventions in the management of obstructive sleep apnoea.

Methods

A systematic review of current literature was undertaken; studies were included if they involved comparison of a non-surgical and/or non-rhinological surgical intervention with a rhinological surgical intervention for treatment of obstructive sleep apnoea.

Results

Sixteen studies met the selection criteria. The pooled data suggest that there are reductions in the apnoea/hypopnea index and respiratory disturbance index following nasal surgery. However, the current body of studies is too heterogeneous for statistically significant meta-analysis to be conducted.

Conclusion

Nasal surgery may have limited benefit for a subset of patients based on current evidence.

Copyright
Corresponding author
Author for correspondence: Professor Bhik T Kotecha, Department of ENT, Royal National Throat, Nose and Ear Hospital, 330 Gray's Inn Road, London WC1X 8EE, UK E-mail: Bhik.kotecha@uclh.nhs.uk
Footnotes
Hide All

Professor B T Kotecha takes responsibility for the integrity of the content of the paper

Footnotes
References
Hide All
1Greenstone, M, Hack, M. Obstructive sleep apnoea. BMJ 2014;348:g3745
2Eckert, DJ, Malhotra, A. Pathophysiology of adult obstructive sleep apnoea. Ann Am Thorac Soc 2008;5:144–53
3Scottish Intercollegiate Guidelines Network. SIGN 73: Management of Obstructive Sleep Apnoea/Hypopnoea Syndrome in Adults. Edinburgh: Scottish Intercollegiate Guidelines Network, 2003
4American Academy of Sleep Medicine. International Classification of Sleep Disorders. Chicago: American Academy of Sleep Medicine, 2001
5Young, T, Palta, M, Dempsey, J, Skatrud, J, Weber, S, Badr, S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328:1230–5
6Antonopoulos, CN, Sergentanis, TN, Daskalopoulou, SS, Petridou, ET. Nasal continuous positive airway pressure (nCPAP) treatment for obstructive sleep apnoea, road traffic accidents and driving simulator performance: a meta-analysis. Sleep Med Rev 2011;15:301–10
7Parati, G, Lombardi, C, Hedner, J, Bonsignore, MR, Grote, L, Tkacova, R et al. Position paper on the management of patients with obstructive sleep apnea and hypertension: joint recommendations by the European Society of Hypertension, by the European Respiratory Society and by the members of European COST (COoperation in Scientific and Technological research) ACTION B26 on obstructive sleep apnea. J Hypertens 2012;30:633–46
8Montesi, SB, Edwards, BA, Malhotra, A, Bakker, JP. The effect of continuous positive airway pressure treatment on blood pressure: a systematic review and meta-analysis of randomised controlled trials. J Clin Sleep Med 2012;8:587–96
9Barbé, F, Durán-Cantolla, J, Sánchez-de-la-Torre, M, Martínez-Alonso, M, Carmona, C, Barceló, A et al. Effect of continuous positive airway pressure on the incidence of hypertension and cardiovascular events in nonsleepy patients with obstructive sleep apnea: a randomized controlled trial. JAMA 2012;307:2161–8
10Gottlieb, DJ, Yenokyan, G, Newman, AB, O'Connor, GT, Punjabi, NM, Quan, SF et al. Prospective study of obstructive sleep apnoea and incident coronary heart disease and heart failure: the sleep heart health study. Circulation 2010;122:352–60
11Sullivan, CE, Issa, FG, Berthon-Jones, M, Eves, L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1981;1:862–5
12Gay, P, Weaver, T, Loube, D, Iber, C. Evaluation of positive airway pressure treatment for sleep related breathing disorders in adults. Sleep 2006;29:381401
13Epstein, LJ, Kristi, D, Strollo, PJ, Friedman, N, Malhotra, A, Patil, SP et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 2009;5:263–76
14Weaver, T, Grunstein, R. Adherence to continuous positive airway pressure therapy. The challenge to effective treatment. Proc Am Thorac Soc 2008;5:173–8
15Takaesu, Y, Tsuiki, S, Kobayashi, M, Komada, Y, Nakayama, H, Inoue, Y. Mandibular advancement device as a comparable treatment to nasal continuous positive airway pressure for positional obstructive sleep apnea. J Clin Sleep Med 2016;12:1113–19
16Smith, BE, Guyette, TW. Estimation of nasal cross-sectional areas, using oral versus nasal pressure measurements. Cleft Palate J 1988;25:199202
17Park, SS. Flow-regulatory function of upper airway in health and disease: a unified pathogenetic view of sleep-disordered breathing. Lung 1993;171:311–33
18Meurice, JC, Marc, I, Carrier, G, Sériès, F. Effects of mouth opening on upper airway collapsibility in normal sleeping subjects. Am J Respir Crit Care Med 1996;153:255–9
19Berry, RB, Kouchi, KG, Bower, JL, Light, RW. Effect of upper airway anesthesia on obstructive sleep apnea. Am J Respir Crit Care Med 1995;151:1857–61
20Haight, JSJ, Djupesland, PG. Nitric oxide (NO) and obstructive sleep apnoea (OSA). Sleep Breath 2003;7:5361
21Suratt, PM, Turner, BL, Wilhoit, SC. Effect of intranasal obstruction on breathing during sleep. Chest 1986;90:324–9
22Fokkens, WJ, Lund, VJ, Mullol, J, Bachert, C, Alobid, I, Baroody, F et al. EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists. Rhinology 2012;50:112
23Georgegalas, C. The role of the nose in snoring and obstructive sleep apnoea: an update. Eur Arch Otorhinolaryngol 2011;268:1365–73
24Poirrier, AL, Ahluwalia, S, Goodson, A, Ellis, M, Bentley, M, Andrews, P. Is the Sino-Nasal Outcome Test-22 a suitable evaluation for septorhinoplasty? Laryngoscope 2013;123:7681
25Andrews, PJ, Choudhury, N, Takhar, A, Poirrier, AL, Jacques, T, Randhawa, PS. The need for an objective measure in septorhinoplasty surgery: are we any closer to finding an answer? Clin Otolaryngol 2015;40:698704
26Hopkins, C, Gillet, S, Slack, R, Lund, V, Browne, JP. Psychometric validity of the 22-item Sinonasal Outcome Test. Clin Otolaryngol 2009;34:447–53
27Andrews, PJ, Poirrier, AL, Lund, VJ, Choi, D. Outcomes in endoscopic sinus surgery: olfaction, NOSE scale and quality of life in a prospective cohort study. Clin Otolaryngol 2016;41:798803
28Whitcroft, KL, Andrews, PJ, Randhawa, PS. Peak nasal inspiratory flow correlates with quality of life in functional endoscopic sinus surgery. Clin Otolaryngol 2017;42:1187–92
29Bican, A, Kahraman, A, Bora, I, Kahveci, R, Hakyemez, B. What is the efficacy of nasal surgery in patients with obstructive sleep apnea syndrome? J Craniofac Surg 2010;21:1801–6
30Choi, JH, Kim, EJ, Cho, WS, Kim, YS, Choi, J, Kwon, SY et al. Efficacy of single-staged modified uvulopalatopharyngoplasty with nasal surgery in adults with obstructive sleep apnea syndrome. Otolaryngol Head Neck Surg 2011;144:994–9
31Choi, JH, Kim, EJ, Kim, YS, Kim, TH, Choi, J, Kwon, SY et al. Effectiveness of nasal surgery alone on sleep quality, architecture, position, and sleep-disordered breathing in obstructive sleep apnea syndrome with nasal obstruction. Am J Rhinol Allergy 2011;25:338–41
32Friedman, M, Tanyeri, H, Lim, JW, Landsberg, R, Vaidyanathan, K, Caldarelli, D. Effect of improved nasal breathing on obstructive sleep apnea. Otolaryngol Head Neck Surg 2000;122:71–4
33Kim, ST, Choi, JH, Jeon, HG, Cha, HE, Kim, DY, Chung, YS. Polysomnographic effects of nasal surgery for snoring and obstructive sleep apnea. Acta Otolaryngol 2004;124:297300
34Koutsourelakis, I, Georgoulopoulos, G, Perraki, E, Vagiakis, E, Roussos, C, Zakynthinos, SG. Randomised trial of nasal surgery for fixed nasal obstruction in obstructive sleep apnoea. Eur Respir J 2008;31:110–17
35Li, H-Y, Lee, LA, Wang, PC, Chen, NH, Lin, Y, Fang, TJ. Nasal surgery for snoring in patients with obstructive sleep apnea. Laryngoscope 2008;118:354–9
36Li, H-Y, Lee, LA, Wang, PC, Fang, TJ, Chen, NH. Can nasal surgery improve obstructive sleep apnea: subjective or objective? Am J Rhinol Allergy 2009;23:51–5
37Nakata, S, Noda, A, Yasuma, F, Morinaga, M, Sugiura, M, Katayama, N et al. Effects of nasal surgery on sleep quality in obstructive sleep apnea syndrome with nasal obstruction. Am J Rhinol 2008;22:5963
38Pang, KP. One-stage nasal and multi-level pharyngeal surgery for obstructive sleep apnoea: safety and efficacy. J Laryngol Otol 2005;119:272–6
39Park, CY, Hong, JH, Lee, JH, Lee, KE, Cho, HS, Lim, SJ et al. Clinical effect of surgical correction for nasal pathology on the treatment of obstructive sleep apnea syndrome. PLoS One 2014;9:e98765
40Sériès, F, St Pierre, S, Carrier, G. Surgical correction of nasal obstruction in the treatment of mild sleep apnoea: importance of cephalometry in predicting outcome. Thorax 1993;48:360–3
41Shuaib, SW, Undavia, S, Lin, J, Johnson, CM, Stupak, HD. Can functional septorhinoplasty independently treat obstructive sleep apnea? Plast Reconstr Surg 2015;135:1554–65
42Sufioğlu, M, Ozmen, OA, Kasapoglu, F, Demir, UL, Ursavas, A, Erişen, L et al. The efficacy of nasal surgery in obstructive sleep apnea syndrome: a prospective clinical study. Eur Arch Otorhinolaryngol 2012;269:487–94
43Verse, T, Maurer, JT, Pirsig, W. Effect of nasal surgery on sleep-related breathing disorders. Laryngoscope 2002;112:64–8
44Virkkula, P, Bachour, A, Hytönen, M, Salmi, T, Malmberg, H, Hurmerinta, K et al. Snoring is not relieved by nasal surgery despite improvement in nasal resistance. Chest 2006;129:81–7
45Hoffstein, V, Viner, S, Mateika, S, Conway, J. Treatment of obstructive sleep apnea with nasal continuous positive airway pressure. Patient compliance, perception of benefits, and side effects. Am Rev Respir Dis 1992;145:841–5
46Camacho, M, Zaghi, S, Tran, D, Song, SA, Chang, ET, Certal, V. Inferior turbinate size and CPAP titration based treatment pressures: no association found among patients who have not had nasal surgery. Int J Otolaryngol 2016;2016:5951273
47Sériès, F, St Pierre, S, Carrier, G. Effects of surgical correction of nasal obstruction in the treatment of obstructive sleep apnoea. Am Rev Respir Dis 1992;146:1261–5
48Camacho, M, Riaz, M, Capasso, R, Ruoff, CM, Guilleminault, C, Kushida, CA et al. The effect of nasal surgery on continuous positive airway pressure device use and therapeutic pressures: a systematic review and meta-analysis. Sleep 2015;38:279–86
49Sher, AE, Schechtman, KB, Piccirillo, JF. The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnoea. Sleep 1996;19:156–77
50Bruce, I, Harman, N, Williamson, P, Tierney, S, Callery, P, Mohiuddin, S et al. The management of otitis media with effusion in children with cleft palate (mOMEnt): a feasibility study and economic evaluation. Health Technol Assess 2015;19:1374
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed