Background: Nasal surgery is commonly involved in surgical treatment for obstructive sleep apnea (OSA). The aim of this study was to investigate the outcomes of nasal surgery for OSA using evidence-based methodology. Methods: The MedLine database (1999∼2009) was searched for original articles published in peer-reviewed journals concerning nasal surgery for snoring/sleep apnea. Data extracted from these articles were reviewed and analyzed using meta-analysis technology. Results: Thirteen articles were critically appraised. Two studies provided control groups and 11 articles (84.6%) consisted of prospective noncontrolled clinical trials (level II in evidence strength). The weighted mean apnea/hypopnea index measured by polysomnography in nine studies decreased from 35.2 ± 22.6 to 33.5 ± 23.8 event/hour after nasal surgery (overall, p = 0.69). The pooled success rate of nasal surgery in treating OSA was 16.7%. Epworth Sleepiness Scale scores in eight studies decreased from 10.6 ± 3.9 to 7.1 ± 3.7 (overall, p <0.001). Nasal surgery for snoring assessed by individual questionnaires and visual analog scale reported significant improvement (p < 0.05). Conclusion: The critical literature appraisal and meta-analyses show that nasal surgery can effectively reduce daytime sleepiness and snoring. However, the efficacy of nasal surgery in treating OSA is limited.

Obstructive sleep apnea (OSA) is characterized by episodes of complete or partial pharyngeal obstruction during sleep. Patients with OSA (hereafter referred to as OSA patients) principally complain of snoring and daytime sleepiness. Nasal obstruction is common in OSA patients, causing disturbed sleep architecture and sleep fragmentation and leading to daytime tiredness and poor quality of life (QOL).¹ A population-based study demonstrated that nasal obstruction, particularly self-reported nocturnal nasal congestion, is a strong independent risk factor for habitual snoring, sleepiness, and nonrestorative sleep.²

To evaluate and compare outcomes of uvulopalato-pharyngoplasty (UPPP) for obstructive sleep apnea/hypopnea syndrome (OSAHS) using anatomy- and severity-based staging systems. Prospective design with a retrospective review. A tertiary-care, sleep disorder referral center. In total, 110 patients with OSAHS (105 men, 5 women; mean age, 43 years; apnea-hypopnea index, 44.4 ± 28.8 events per hour; body mass index, 27.1 ± 3.3 kg/m²). An anatomy-based staging system (stages I–IV) was used to classify patients with OSAHS by examining tongue-palate position, tonsil size, body mass index, and craniofacial deformities. Patients were also classified as having mild, moderate, moderate-severe, or severe OSAHS based on preoperative apnea-hypopnea index from polysomnography (a severity-based staging system). Surgical success was defined as a 50% or greater reduction in the apnea-hypopnea index and a postoperative apnea-hypopnea index of less than 20 events per hour. UPPP was performed in all patients. The overall success rate of UPPP was 78%. Success rates for mild (90%), moderate (73%), moderate-severe (81%), and severe (74%) diseases were similar (p = .10). Conversely, success rates for patients with anatomy-based stages I, II, III, and IV were 100%, 96%, 65%, and 20%, respectively; these rates were significantly different (p < .001). Changes in apnea-hypopnea index were significantly correlated with Friedman tongue position (FTP)(r = −0.33, p = .0004) and tonsil size (r = −0.37, p < .0001). The FTP (odds ratio = 0.43, SE = 0.13, p = .005, 95% confidence interval = 0.24–0.78) and tonsil size (odds ratio = 3.13, SE = 1.53, p = .02, 95% confidence interval = 1.20–8.17), but not the severity-based staging (odds ratio = 0.77, SE=0.18, p = .283, 95% confidence interval = 0.49–1.23), were predictive of surgical success. The anatomy-based staging system predicted UPPP outcomes more effectively than did the severity-based staging. The anatomy-based staging system facilitates good case-selection information for counseling patients before UPPP surgery.