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SLEEP MEDICINE: Paula Virkkula, Adel Bachour, Maija Hytönen, Tapani Salmi, Henrik Malmberg, Kirsti Hurmerinta, and Paula Maasilta Snoring Is Not Relieved by Nasal Surgery Despite Improvement in Nasal Resistance Chest 2006; 129: 81-87 [Abstract] [Full text] [PDF]

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Nasal Surgery in OSA Patients

Murat Enoz   (27 July 2007)

Nasal Surgery in OSA Patients 27 July 2007
Murat Enoz, Maresal Cakmak Military Hospital, Deparment of ORL & Head and Neck Surgery Erzurum, Turkey. Send letter to journal: Re: Nasal Surgery in OSA Patients muratenoz{at}gmail.com Murat Enoz	Dear Editor, I read with great interest the article by Dr. Virkkula et al. entitled “Snoring is not relieved by nasal surgery despite improvement in nasal resistance.” in the January 2006 issue of The Chest(1). In their study, snoring and nasal resistance are evaluated preoperatively and postoperatively. The selected patients in this study have normal cephalometric findings thus who have normal hypopharengeal area. The mention about nasal surgery and sleep apnea is still controversial to the literature. Nasal structural alterations; septal deviation and / or conchal hypertrophy or other pathologies lead to obstruction of nasal passage. A narrow nasal air flow may increase the velocity of nasal airflow and exacerbate collapse of the pharyngeal airway by means of Bernoulli’s force; this mechanism may therefore aggravate the symptoms of OSA(2). Several studies have shown that increased nasal resistance may induce sleep-related breathing disorders (SRBD) and cause disturbed sleep(3, 4); however, contradictory results have also been obtained(5). However, nasal surgery usually has a very positive effect on improving the quality of life and CPAP tolerance in patients with coexisting nasal pathology (e.g. nasal polyposis, deviated septum, turbinate hypertrophy) (6, 7). In the present study(1) they found that snoring was not relieved despite decreasing in nasal resistance. This result may be related with palatopharyngeal denervation in study subjects due to chronic OSAS. Sincerely, Dr.Murat Enoz References 1. Virkkula P, Bachour A, Hytonen M, Salmi T, Malmberg H, Hurmerinta K, Maasilta P. Snoring is not relieved by nasal surgery despite improvement in nasal resistance. Chest. 2006 Jan;129(1):81-7. 2. Kao YH, Shnayder Y, Lee KC. The efficacy of anatomically based multilevel surgery for obstructive sleep apnea. Otolaryngol Head Neck Surg 2003;129:327–35. 3. Fogel RB, Malhotra A, White DP. Sleep. 2: pathophysiology of obstructive sleep apnoea/hypopnoea syndrome. Thorax. 2004 Feb;59(2):159- 63. 4. Gislason T, Almqvist M, Eriksson G, Taube A, Boman G. Prevalence of sleep apnea among Swedish men: an epidemiological study. J Clin Endocrinol 1988;41:571–6. 5. Kramer MF, De La Chaux R, Dreher A, Pfrogner E, Rasp G. Allergic rhinitis does not constitute a risk factor for obstructive sleep apnea syndrome. Acta Otolaryngol 2001;121:494–9. 6. Enoz M, Gozeler MS. Nasal resistance and OSA. Rev Bras Otorrinolaringol (Engl Ed). 2006 Sep-Oct;72(5):719. 7. Enoz M. Effects of Nasal Pathologies on Obstructive Sleep Apnea. Acta Medica (Hradec Kralove). (Article in press)