Hostname: page-component-89b8bd64d-46n74 Total loading time: 0 Render date: 2026-05-13T21:22:09.736Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  21 February 2019

S Sharma ,
J C R Wormald ,
J M Fishman ,
P Andrews  and
B T Kotecha
S Sharma
Affiliation:
Department of ENT, Queens Medical Centre, Nottingham, UK
J C R Wormald
Affiliation:
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK Department of Plastic and Reconstructive Surgery, Stoke Mandeville Hospital, Aylesbury, UK
J M Fishman
Affiliation:
Department of ENT, Royal National Throat, Nose and Ear Hospital, London, UK UCL Ear Institute, London, UK
P Andrews
Affiliation:
Department of ENT, Royal National Throat, Nose and Ear Hospital, London, UK UCL Ear Institute, London, UK
B T Kotecha*
Affiliation:
Department of ENT, Royal National Throat, Nose and Ear Hospital, London, UK
*
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
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

Obstructive Sleep ApneaSleep Apnea SyndromesNasal Surgical ProceduresRhinosurgeryNasal Surgery

Information

Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 133 , Issue 3 , March 2019 , pp. 168 - 176
Copyright
Copyright © JLO (1984) Limited, 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

Footnotes

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

References

1Greenstone, M, Hack, M. Obstructive sleep apnoea. BMJ 2014;348:g3745Google Scholar
2Eckert, DJ, Malhotra, A. Pathophysiology of adult obstructive sleep apnoea. Ann Am Thorac Soc 2008;5:144–53Google Scholar
3Scottish Intercollegiate Guidelines Network. SIGN 73: Management of Obstructive Sleep Apnoea/Hypopnoea Syndrome in Adults. Edinburgh: Scottish Intercollegiate Guidelines Network, 2003Google Scholar
4American Academy of Sleep Medicine. International Classification of Sleep Disorders. Chicago: American Academy of Sleep Medicine, 2001Google Scholar
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;328:1230–5Google Scholar
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;15:301–10Google Scholar
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;30:633–46Google Scholar
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;8:587–96Google Scholar
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;307:2161–8Google Scholar
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;122:352–60Google Scholar
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;1:862–5Google Scholar
12Gay, P, Weaver, T, Loube, D, Iber, C. Evaluation of positive airway pressure treatment for sleep related breathing disorders in adults. Sleep 2006;29:381–401Google Scholar
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;5:263–76Google Scholar
14Weaver, T, Grunstein, R. Adherence to continuous positive airway pressure therapy. The challenge to effective treatment. Proc Am Thorac Soc 2008;5:173–8Google Scholar
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;12:1113–19Google Scholar
16Smith, BE, Guyette, TW. Estimation of nasal cross-sectional areas, using oral versus nasal pressure measurements. Cleft Palate J 1988;25:199–202Google Scholar
17Park, SS. Flow-regulatory function of upper airway in health and disease: a unified pathogenetic view of sleep-disordered breathing. Lung 1993;171:311–33Google Scholar
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;153:255–9Google Scholar
19Berry, RB, Kouchi, KG, Bower, JL, Light, RW. Effect of upper airway anesthesia on obstructive sleep apnea. Am J Respir Crit Care Med 1995;151:1857–61Google Scholar
20Haight, JSJ, Djupesland, PG. Nitric oxide (NO) and obstructive sleep apnoea (OSA). Sleep Breath 2003;7:53–61Google Scholar
21Suratt, PM, Turner, BL, Wilhoit, SC. Effect of intranasal obstruction on breathing during sleep. Chest 1986;90:324–9Google Scholar
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;50:1–12Google Scholar
23Georgegalas, C. The role of the nose in snoring and obstructive sleep apnoea: an update. Eur Arch Otorhinolaryngol 2011;268:1365–73Google Scholar
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;123:76–81Google Scholar
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;40:698–704Google Scholar
26Hopkins, C, Gillet, S, Slack, R, Lund, V, Browne, JP. Psychometric validity of the 22-item Sinonasal Outcome Test. Clin Otolaryngol 2009;34:447–53Google Scholar
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;41:798–803Google Scholar
28Whitcroft, KL, Andrews, PJ, Randhawa, PS. Peak nasal inspiratory flow correlates with quality of life in functional endoscopic sinus surgery. Clin Otolaryngol 2017;42:1187–92Google Scholar
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;21:1801–6Google Scholar
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;144:994–9Google Scholar
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;25:338–41Google Scholar
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;122:71–4Google Scholar
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;124:297–300Google Scholar
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;31:110–17Google Scholar
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;118:354–9Google Scholar
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;23:51–5Google Scholar
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;22:59–63Google Scholar
38Pang, KP. One-stage nasal and multi-level pharyngeal surgery for obstructive sleep apnoea: safety and efficacy. J Laryngol Otol 2005;119:272–6Google Scholar
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:e98765Google Scholar
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;48:360–3Google Scholar
41Shuaib, SW, Undavia, S, Lin, J, Johnson, CM, Stupak, HD. Can functional septorhinoplasty independently treat obstructive sleep apnea? Plast Reconstr Surg 2015;135:1554–65Google Scholar
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;269:487–94Google Scholar
43Verse, T, Maurer, JT, Pirsig, W. Effect of nasal surgery on sleep-related breathing disorders. Laryngoscope 2002;112:64–8Google Scholar
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;129:81–7Google Scholar
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;145:841–5Google Scholar
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;2016:5951273Google Scholar
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;146:1261–5Google Scholar
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;38:279–86Google Scholar
49Sher, AE, Schechtman, KB, Piccirillo, JF. The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnoea. Sleep 1996;19:156–77Google Scholar
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;19:1–374Google Scholar