Objective assessment of nasal obstruction in snoring and obstructive sleep APNEA patients: Experience of a police authority hospital

Background: The role of nasal airflow resistance in the pathogenesis of obstructive sleep apnea (OSA) syndrome remains contentious. The aim of this study was to investigate the changes in apnea index in response to nasal surgery, as guided by acoustic rhinometry. Patients and Methods: Forty-five patients were referred for complaints of snoring and nasal obstruction. The patients were divided into two groups according to the severity of nasal obstruction: group 1 (nasal obstruction was the predominant symptom) included 21 patients, and group 2 (snoring was the predominant symptom) included 24 patients. In group 1, nasal surgery was performed as a first surgical procedure and was followed after 10-12 weeks by palatal surgery. In group 2, palatal surgery was performed as the primary procedure and was followed after 10-12 weeks by nasal surgery. Results: The results showed a clear relationship between the correction of nasal obstruction and the severity of OSA, as indicated by measuring the apnea index (AI). However, in none of the group 1 cases was nasal surgery alone capable of reducing the AI by 50%. In group 2, palatal surgery effectively reduced AI, and when followed by nasal surgery, the reduction in AI was again statistically significant. Conclusion: This indicates that nasal obstruction could be considered a contributing factor to the severity of OSA, but not a causative factor in the production of OSA. It also indicates that nasal surgery and palatal surgery combined are effective in improving snoring and OSA in properly selected patients.