Relationship between allergic rhinitis and nasal surgery success in patients with obstructive sleep apnea

• Published in: American journal of otolaryngology Vol. 42; no. 6; p. 103079
• Main Authors: Kim, Sung-Dong, Jung, Da-Woon, Lee, Jung-Woo, Park, Ji-Hwan, Mun, Sue-Jean, Cho, Kyu-Sup
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2021; Elsevier Limited
• Subjects: Adolescent; Adult; Aged; Airway management; Allergic rhinitis; Apnea; Body mass index; Child; Endoscopy; Evaluation; Female; Humans; Male; Middle Aged; Nasal obstruction; Nasal Septum - surgery; Nasal surgical procedures; Nose; Nose - physiopathology; Otolaryngology; Oxygen content; Oxygen saturation; Patient Acuity; Patients; Polysomnography; Population studies; Prospective Studies; Respiration; Rhinitis; Rhinitis, Allergic; Sleep; Sleep and wakefulness; Sleep apnea; Sleep apnea, obstructive; Sleep Apnea, Obstructive - diagnosis; Sleep Apnea, Obstructive - physiopathology; Sleep Apnea, Obstructive - surgery; Sleep disorders; Sleepiness; Snoring; Success; Surgery; Treatment Outcome; Turbinates - surgery; Young Adult; Sleep apnea, obstructive; Nasal obstruction; Nasal surgical procedures; Snoring; Rhinitis, allergic
• ISSN: 0196-0709; 1532-818X
• DOI: 10.1016/j.amjoto.2021.103079

Nasal obstruction is common in patients with obstructive sleep apnea (OSA). Nonetheless, the effectiveness of isolated nasal surgery in treatment of OSA remains controversial. This study is to evaluate the subjective and objective outcome after isolated nasal surgery in patients with OSA and to determine the associated factors related to the success rate of isolated nasal surgery. The study population consisted of 35 patients with nasal obstruction who had been diagnosed with OSA and were undergoing septoplasty and inferior turbinate reduction to correct nasal pathologies. Preoperative drug-induced sleep endoscopy was performed to evaluate the obstruction site. Patients were assessed before and after nasal surgery using subjective outcomes measures, including the Visual Analog Scale and Epworth Sleepiness Scale, as well as by overnight polysomnography. All patients experienced improved nasal breathing postoperatively. At 6 months postoperatively, patients exhibited significant symptomatic improvement in snoring, sleep apnea, morning headache, tiredness, and daytime sleepiness. Postoperative polysomnography revealed significant improvement in the apnea-hypopnea index, respiratory disturbance index, and percentage of time with oxygen saturation < 90%. Although the overall success rate of nasal surgery alone was 14.3%, the criteria for success were met in 50% of patients with allergic rhinitis. Furthermore, the success rate was significantly higher in patients with moderate to severe nasal obstruction than in patients with mild nasal obstruction. Among patients with OSA, those with allergic rhinitis and severe nasal obstruction are likely to have a better surgical outcome following isolated nasal surgery.