Effect of surgical correction of nasal cavity pathologic changes on obstructive sleep apnea syndrome severity in patients after laser-assisted uvulopalatoplasty

Background: Nasal obstruction plays an important role in the pathogenesis of rhonchopathy. Narrowing of the nasal cavity, in the presence of certain pathological changes in it, leads to increased resistance to the inspiratory airflow. However, surgical correction of these changes in patients with rhonchopathy and obstructive sleep apnea syndrome does not necessarily reduce pharyngeal obstruction, and the absence of improvement in obstructive sleep apnea syndrome severity following surgical relief of nasal obstruction indicates the ineffectiveness of the intervention.

Aim: This study aimed to evaluate the effect of surgical correction of pathological changes in the nasal cavity on the reduction of obstructive sleep apnea syndrome severity in patients after laser-assisted uvulopalatoplasty (LAU).

Methods: Active anterior rhinomanometry results were analyzed and correlated with data from computer-based pulse oximetry and polysomnography in 72 patients aged 37 to 75 years with rhonchopathy and obstructive sleep apnea syndrome who had undergone LAU and were followed for 5 years. The patients were divided into 3 groups: group 1 (n = 20) included individuals with uncomplicated snoring, normal nasal breathing, no nasal cavity pathology, and no comorbidities; group 2 (n = 26) included patients without comorbidities who, based on clinical indications, underwent preliminary correction of pathologic changes in the nasal cavity (septoplasty, turbinate reduction, or polypectomy), followed by LAU 2 to 6 months later; and group 3 (n = 26) included patients with nasal obstruction and comorbidities who, based on clinical indications, underwent combined single-stage surgery consisting of LAU and correction of pathologic changes in the nasal cavity.

Results: The study showed that, despite the positive effect of surgeries to relieve nasal obstruction—confirmed by active anterior rhinomanometry—and subjective improvement in sleep quality and general well-being reported by the vast majority of operated patients in groups 2 and 3 (45 [86.5%]), a reduction in obstructive sleep apnea syndrome severity after LAU was objectively confirmed by computer-based pulse oximetry and polysomnography in only 18 of 52 patients (34.6%) with obstructive sleep apnea syndrome of varying severity.

Conclusion: Surgical correction of pathologic changes of the nasal cavity reduces the severity of obstructive sleep apnea syndrome in patients who have undergone LAU in only 34.6% of cases.