Polysomnographic effects of nasal surgery for snoring and obstructive sleep apnea

Objective - It has been hypothesized that nasal obstruction causes an increase in negative pressure in the upper airway and induces an inspiratory collapse at the pharyngeal level. We used portable polysomnography (PSG) to assess the efficacy of nasal surgery for snoring and obstructive sleep apnea (OSA). Material and Methods - We reviewed 21 patients who presented with nasal obstruction and snoring. Septal surgery with or without inferior turbinectomy was performed. Each patient was assessed pre- and postoperatively using PSG. We measured the respiratory distress index (RDI), apnea index ( AI), oxygen saturation index (OSI) and the duration of snoring. Selection criteria were an RDI of >15 as determined by PSG and clinical nasal obstruction and a deviated nasal septum as determined by physical examination. Results - Nasal surgery had the following effects: RDI decreased from 39 to 29 (p = 0.0001), AI decreased from 19 to 16 (p = 0.0209), OSI decreased from 48 to 32 (p = 0.0001) and the duration of snoring decreased from 44% to 39% (p = 0.1595). Snoring and OSA were completely relieved in 4 patients (19%) who did not require any additional surgical therapy. Conclusion - Snoring and OSA may be corrected merely by septal surgery in some patients, and secondary surgery (uvulopalatoplasty) may be considered after a thorough evaluation by means of postoperative PSG.