Do the turbinates play an important role in obstructive sleep apnea syndrome? – Our experience

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BACKGROUND. Nasal obstruction may trigger obstructive sleep apnea syndrome (OSAS) and it is considered to be a cofactor in its pathophysiology. However, the relation between cause and effect still remains a matter of debate.

MATERIAL AND METHODS. 18 patients diagnosed with chronic hypertrophic rhinitis and obstructive sleep apnea syndrome were included in the present study. All patients underwent nasal surgery as the single treatment for their sleep breathing disorders. Rhinomanometric (total nasal airflow, logReff, logVR) and polygraphic parameters (apnea-hypopnea index - AHI, snore flags index – SFI) were evaluated pre- and 2 months postoperatively.

RESULTS. There was a statistically significant difference between the values of the preoperative and postoperative total nasal airflow (p-value<0.0001). In case of AHI, there was a decrease in its value from 31.56 preoperatively to 30.03 postoperatively, but the difference was not statistically significant (p=0.937). The SFI, on the other hand, presented a significant decrease (p=0.05), from a mean value of 93.15 preoperatively to 56.02 after the surgery. The correlation of the total nasal airflow with AHI and SFI, revealed that nasal surgery had an important impact upon snoring characteristics (r=0.24) and less upon OSAS severity (r=0.21).

CONCLUSION. The nasal cavity obstruction contributes less to OSAS, but still represents a disorder that needs to be corrected in case of such patients. Turbinates reduction surgery may be applied in the treatment of OSAS and combined with palate and/or tongue surgery.

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  • 1. Rappai M. Collop N. Kemp S. deShazo R. - The nose and sleep-disordered breathing: What we know and what we do not know. Chest 2003;124(6):2309-2323.

  • 2. Scheithauer M.O. - Surgery of the turbinates and “empty nose” syndrome. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2010;9:Doc03. Published online 2011 Apr 27. doi: 10.3205/cto000067.

  • 3. Passali D. Passali F.M. Damiani V. Passali G.C. Bellussi L. - Treatment of inferior turbinate hypertrophy: a randomized clinical trail. Ann Otol Rhinol Laryngol. 2003;112(8):683-688.

  • 4. Joniau S. Wong I. Rajapaksa S. Carney S.A. Wormald P.J. - Longterm comparison between submucosal cauterization and powered reduction of the inferior turbinates. Laryngoscope 2006;116(9):1612-1616.

  • 5. Vogt K. Shah-Hosseini K. Mosges R. Pallanch J. Hasse W. – New parameters in 4-phase-rhinomanometry relations between objective findings and the sensation of obstruction. A statistical evaluation of 1580 cases. Rhinology 2010;Suppl 21:25-31.

  • 6. Verse T. Pirsig W. - Nasal surgery. In: Hörmann K. Verse T. - Surgery for Sleep Disordered Breathing. 2nd Edition. Springer-Verlag Berlin Heidelberg 2010 2005;p.35-41.

  • 7. Zwillich C.W. Pickett C. Hanson F.N. Weil J.V. - Disrupted sleep and prolonged apnea during nasal obstruction in normal men. Am Rev Respir Dis. 1981;124:158-160.

  • 8. Olsen K.D. Kern E.B. Westbrook P.R. - Sleep and breathing disturbances secondary to nasal obstruction. Otolaryngol Head Neck Surg. 1981;89:804-810.

  • 9. Wetmore S.J. Scrima L. Hiller F.C. - Sleep apnea in epistaxis patients treated with nasal packs. Otolaryngol Head Neck Surgery 1988;98:596-599.

  • 10. Liistro G. Rombaux Ph. Belge C. Dury M. Aubert G. Rodenstein D. - High Mallampati score and nasal obstruction are associated risk factors for obstructive sleep apnea. Eur Respir J. 2003;21:248-252.

  • 11. De Vito A. - The importance of nasal resistance in obstruction sleep apnea syndrome: a study with positional rhinomanometry. Sleep Breath 2001;5:3-11.

  • 12. Ohki M. Usui N. Kanazawa H. Hara I. Kawano K. - Relationship between oral breathing and nasal obstruction in patients with obstruction sleep apnea. Acta Otolaryngol Suppl. 1996;52:228-230.

  • 13. Virkkula P. Maasilta P. Hytonen M. Salmi T. Malmberg H. - Nasal obstruction and sleep-disordered breathing: the effects of supine body position on nasal measurements in snorers. Acta Otolaryngol (Stockh) 2003;123:648-654.

  • 14. Metes A. Cole P. Hoffstein V. Miljeteig H. - Nasal airway dilation and obstructed breathing in sleep. Laryngoscope 1992;102:1053-1055.

  • 15. Young T. Finn L. Kim H. - Chronic nasal congestion at night is a risk factor for snoring: in population – based cohort study. Arch Intern Med. 2001;161:1514-1519.

  • 16. Miljeteig H. Hoffstein V. Cole P. - The effects of unilateral and bilateral nasal obstruction on snoring and sleep apnea. Laryngoscope 1993;102:1150-1152.

  • 17. Miljeteig H. Savard P. Mateika S. Cole P. Haight J.S. Hoffstein V. - Snoring and nasal resistance during sleep. Laryngoscope 1993;103:918-923.

  • 18. Jessen M. Fryrsmark U. - Is there a relationship between the degree of nasal obstruction and the snoring ? Clin Otolaryngol. 1993;18:485-487.

  • 19. Sher A.E. Schechtman K.B. Piccirillo J.F. - The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep 1996;19:156–177.

  • 20. Rubin A.H. Eliaschar I. Joachim Z. Alroy G. Lavie P. - Effects of nasal surgery and tonsillectomy on sleep apnea. Bull Eur Physiopathol Respir. 1983;19:612–615.

  • 21. Dayal V.S. Phillipson E.A. - Nasal surgery in the management of sleep apnea. Ann Otol Rhinol Laryngol. 1985;94:550–554.

  • 22. Caldarelli D.D. Cartwright R. Lilie J.K. - Obstructive sleep apnea: variations in surgical management. Laryngoscope 1985;95:1070–1073.

  • 23. Kim S.T. Choi J.H. Jeon H.G. Cha H.E. Kim D.Y. Chung Y.S. - Polysomnographic effects of nasal surgery for snoring and obstructive sleep apnea. Acta Otolaryngol. 2004;124:297–300.

  • 24. Friedman M. Tanyeri H. Lim J.W. Landsberg R. Vaidyanathan K. Caldarelli D. - Effect of improved nasal breathing on obstructive sleep apnea. Otolaryngol Head Neck Surg. 2000;122:71–74.

  • 25. Sériès F. Pierre S. St Carrier G. - Effects of surgical correction of nasal obstruction in the treatment of obstructive sleep apnea. Am Rev Respir Dis. 1992;146:1261–1265.

  • 26. Sériès F. Pierre S. St Carrier G. - Surgical correction of nasal obstruction in the treatment of mild sleep apnoea: importance of cephalometry in predicting outcome. Thorax 1993;48:360–363.

  • 27. Utley D.S. Shin E.J. Clerk A.A. Terris D.J. - A cost-effective and rational surgical approach to patients with snoring upper airway resistance syndrome or obstructive sleep apnea syndrome. Laryngoscope 1997;107:726–734.

  • 28. Verse T. Maurer J.T. Pirsig W. - Effect of nasal surgery on sleep related breathing disorders. Laryngoscope 2002;112:64–68.

  • 29. Fairbanks D.N.F. - Snoring: surgical vs. nonsurgical management. Laryngoscope 1984;94:1188–1192.

  • 30. Ellis PDM Harris MLL Williams JE Shneerson JM. The relief of snoring by nasal surgery. Clin Otolaryngol 1992;17:525–527.

  • 31. Elsherif I. Hussein S.N. - The effect of nasal surgery in snoring. Am J Rhinol. 1998;12:77–79.

  • 32. Bertrand B. Eloy P. Collet S. Remarque C. Rombeaux P. - Effect of nasal valve surgery by open-septorhinoplasty and lateral cartilage grafts (spreader grafts) on snoring among a population of single snorers. Preliminary report. Acta Otorhinolaryngol Belg. 2002;56:149–155.

  • 33. Schäfer J. - Spektralanalyse pathologischer schlafabhängiger Atemgeräusche der oberen Luftwege unter besonderer Berücksichtigung der Diagnostik und Therapie des obstruktiven Schlafapnoe-Syndroms und chronischer Rhonchopathien [in German]. University of Ulm Ulm Germany 1990 Thesis.

  • 34. Mayer-Brix J. Becker H. Peter J.H. - Nasal high pressure ventilation in obstructive sleep apnea syndrome. Theoretical and practical otorhinolaryngologic aspects [in German]. Laryngorhinootologie 1989;68:295–298.

  • 35. Dorn M. Pirsig W. Verse T. - Management of patients with severe obstructive sleep apnea following rhinosurgical interventions. A pilot study [in German]. HNO 2001;49:642–645.

  • 36. Masdon J.L. Magnuson J.S. Youngblood G. - The effects of upper airway surgery for obstructive sleep apnea on nasal continuous positive airway pressure settings. Laryngoscope 2004;114:205–207.

  • 37. Nakata S. Noda A. Yagi H. Yanafi E. Mimura T. Okada T. Misawa H. Nakashima T. - Nasal resistance for determinant factor of nasal surgery in CPAP failure patients with obstructive sleep apnea syndrome. Rhinology 2005;44:296–299.

  • 38. Zonato A.I. Bittencourt L.R. Martinho F.L. Gregório L.C. Tufik S. - Upper airway surgery: the effect on nasal continuous positive airway pressure titration on obstructive sleep apnea patients. Eur Arch Otorhinolaryngol. 2006;263:481–486.

  • 39. Verse T. Pirsig W. Kroker B.A. - Obstructive sleep apnea and nasal polyps [in German]. Laryngorhinootologie 1998;77:150–152.

  • 40. Virkkula P. Bachour A. Hytönen M. Salmi T. Malmberg H. Hurmerinta K. Maasilta P. - Snoring is not relieved by nasal surgery despite improvement in nasal resistance. Chest 2006;129:81–87.

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