[Influence of nasal obstruction on sleep-associated breathing disorders]

The influence of nasal obstruction on sleep associated breathing disorders (SABD) and the controversial effects of surgical treatment are discussed.

Complete nasal obstruction caused by nasal packing increases SABD, but varies from patient to patient and depends on age and individual anatomy. Especially patients with preexisting obstructive sleep apnea syndrome (OSAS) can develop severe complications. Some authors found a higher frequency of SABD in patients with nasal obstruction due to anatomical alterations, i.e. septal deviation, while others denied this connection. Major causes for the development of SABD in nasal obstruction include certain reflex mechanisms, increased negative inspiration pressure with a tendency for pharyngeal collapse, and transition to transoral breathing. Intermittent dilatation of the nasal valve using stents or tapes will lead to a decrease of nasal airway resistance and might also result in an improvement of SABD according to some studies, while others did not find any improvement. The results of controversial operative treatment in nasal airway obstruction are also described and include complete healing of high degree OSAS, improvement of sleep quality, and elimination of snoring. On the other hand, surgery might also be completely unsuccessful or even induce OSAS.

As the effect of any kind of nasal operation on SABD is unpredictable from our present knowledge, the decision whether or not nasal surgery is indicated should depend on the individual situation of the patient. If OSAS is suspected, preoperative and post-operative polysomnography should be performed.