An observational cohort study of the effects of septoplasty with or without inferior turbinate reduction in patients with obstructive sleep apnea
Tóm tắt
The objective of this observational study was to evaluate the outcomes of intranasal surgery in patients with obstructive sleep apnea (OSA) in a single institution in Norway. Fifty-nine patients with OSA and clinically significant nasal obstruction underwent either septoplasty alone or septoplasty with concomitant volume reduction of the turbinates from August 2008 until the end of December 2010. Subjects were scheduled for sleep polygraphy before and 3 months after treatment. In this observational single-centre cohort study we evaluated and compared the effect of these two specific surgical procedures on sleep related parameters. There was a significant reduction in the apnea-hypopnea index (AHI) only in the group that had septoplasty with turbinate reduction (17.4, (SD 14.4) – 11.7, (SD 8.2), p <0.01), and this effect was significantly better than in the group treated with septoplasty alone. Other objective parameters remained unchanged. Subjective assessments obtained with a postoperative questionnaire showed an equally positive effect on diurnal sleepiness and nasal obstruction in both groups, and a better effect on sleep quality in the combined treatment group. The effect of nasal surgery on obstructive sleep apnea seemed to be greater when there were indications for combined surgery of the inferior turbinates and the nasal septum, compared to when there were indications for septoplasty alone.
Tài liệu tham khảo
Mullington JM, Haack M, Toth M, Serrador J, Meier-Ewert H: Cardiovascular, inflammatory and metabolic consequences of sleep deprivation. Prog Cardiovasc Dis. 2009, 51 (4): 294-302. 10.1016/j.pcad.2008.10.003.
Longobardo GS, Evangelisti CJ, Cherniack NS: Analysis of the interplay between neurochemical control of respiration and upper airway mechanics producing upper airway obstruction during sleep in humans. Exp Physiol. 2008, 93 (2): 271-287.
Van Hirtum A, Pelorson X, Lagrée PY: In vitro validation of some flow assumptions for the prediction of the pressure distribution during obstructive sleep apnea. Med Biol Eng Comput. 2005, 43 (1): 162-171. 10.1007/BF02345139.
Powell NB: Contemporary surgery for obstructive sleep apnea syndrome. Clin Exp Otorhinolaryngol. 2009, 2 (3): 107-114. 10.3342/ceo.2009.2.3.107.
Li H, Lin Y, Chen N, Lee L, Fang T, Wang P: Improvement in quality of life after nasal surgery alone for patients with obstructive sleep apnea and nasal obstruction. Arch Otolaryngol Head and Neck Surg. 2008, 134 (4): 429-433. 10.1001/archotol.134.4.429.
Georgolas C: The role of the nose in snoring and obstructive sleep apnoea: an update. Eur Arch Otorhinolaryngol. 2011, 268 (9): 1365-1373. 10.1007/s00405-010-1469-7.
Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody F, Cohen N, Cervin A, Douglas R, Gevaert P, Georgalas C, Goossens H, Harvey R, Hellings P, Hopkins C, Jones N, Joos G, Kalogjera L, Kern B, Kowalski M, Price D, Riechelmann H, Schlosser R, Senior B, Thomas M, Toskala E, Voegels R, Wang de Y, Wormald PJ: EPOS 2012: European postion paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists. Rhinology. 2012, 50 (1): 1-12.
Sher AE, Schechtman KB, Piccirillo JF: The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep. 1996, 19 (2): 156-177.
Verse T, Maurer JT, Pirsig W: Effect of nasal surgery on sleep-related breathing disorders. Laryngoscope. 2002, 112 (1): 64-68. 10.1097/00005537-200201000-00012.
Koutserelakis I, Georgoulopoulos G, Perraki E, Vagiakis E, Roussos C, Zakynthinos SG: Randomised trial of nasal surgery for fixed nasal obstruction in obstructive sleep apnea. Eur Respir J. 2008, 31 (1): 110-117. 10.1183/09031936.00087607.
Li HY, Wang PC, Chen YP, Lee LA, Fang TJ, Lin HC: Critical appraisal and meta-analysis of nasal surgery for obstructive sleep apnea. Am J Rhinol Allergy. 2011, 25 (1): 45-49. 10.2500/ajra.2011.25.3558.
Kim ST, Choi JH, Jeon HG, Cha HE, Kim DY, Chung YS: Polysomnographic effects of nasal surgery for snoring and obstructive sleep apnea. Acta Otolaryngol. 2004, 124: 297-300. 10.1080/00016480410016252.
Li HY, Lee LA, Wang PC, Fang TJ, Chen NH: Can nasal surgery improve obstructive sleep apnea: Subjective or objective?. Am J Rhinol Allergy. 2009, 23: e51-e55. 10.2500/ajra.2009.23.3358.
Friedman M, Tanyeri H, Lim JW, Landsberg R, Vaidyanathan K, Caldarelli D: Effect of improved nasal breathing on obstructive sleep apnea. Otolaryngol Head Neck Surg. 2000, 122: 71-74. 10.1016/S0194-5998(00)70147-1.
Morinaga M, Nakata S, Yasuma F, Noda A, Yagi H, Tagaya M, Suqiura M, Teranishi M, Nakashima T: Pharyngeal morphology: A determinant of successful nasal surgery for sleep apnea. Laryngoscope. 2009, 119: 1011-1016. 10.1002/lary.20175.
Rollheim J, Tvinnereim M, Sitek J, Osnes T: Repeatibility of sites of sleep-induced upper airway obstruction. A 2-night study based on recordings of airway pressure and flow. Eur Arch Otorhinolaryngol. 2001, 258 (5): 259-264. 10.1007/s004050100330.
The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6815/14/11/prepub