Effects of nasal surgery on the upper airway: a drug-induced sleep endoscopy study

To evaluate the impact of nasal surgery on the oropharyngeal and hypopharyngeal anatomy of patients with obstructive sleep apnea (OSA) by comparing drug-induced sleep endoscopy (DISE) data prior to and following nasal surgery.

Retrospective review of medical records and DISE video recordings.

Twenty-four patients with OSA were identified who underwent nasal surgery for symptomatic nasal obstruction. Clinic charts and DISE video recordings were reviewed. Preoperative and postoperative DISE recordings were compared to determine whether nasal surgery affected the level, degree, and sustainability of upper airway obstruction.

Overall, the pattern of upper airway obstruction did not change significantly following nasal surgery (P > .05). Almost all patients demonstrated residual obstruction by postoperative DISE (96%), with no change in plans for surgical management of oropharyngeal and hypopharyngeal collapse (83%). Partial improvement in palatal collapse was present in a subset of patients without tongue base obstruction (P < .05). Postoperative apnea-hypopnea index decreased from a mean of 23.6 to 20.4 events/hr, but this change was not significant (P > .05).

For most patients with OSA, surgical repair of nasal obstruction does not significantly improve oropharyngeal or hypopharyngeal collapse as seen on DISE. However, mild improvement in palatal collapse is seen in a subset of patients without tongue base obstruction. This study reveals that if DISE is being utilized to direct surgical management of OSA, it does not need to be repeated for most patients after nasal surgery.