Postoperative Sleep Outcomes in Empty Nose Syndrome: Associations With Psychiatric Symptomatology

Empty nose syndrome (ENS) is an iatrogenic condition characterized by paradoxical nasal obstruction and significant impairments in mental status and sleep function. Reconstructive surgery aims to improve the symptoms and overall well-being of patients with ENS. In this study, we investigated the effects of reconstructive surgery on sleep outcomes in patients with ENS, emphasizing clinically meaningful improvements beyond questionnaire score changes.

We prospectively enrolled patients with ENS undergoing surgical reconstruction. We assessed patients pre-reconstructively and at 6 months post-reconstructively, including polysomnography (PSG) and using subjective questionnaires, including the Empty Nose Syndrome Six-Item Questionnaire (ENS6Q), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (EpSS), Beck Depression Inventory-II (BDI-II), and Beck Anxiety Inventory (BAI).

This study enrolled 39 patients undergoing surgical reconstruction. Post-reconstruction ENS6Q, PSQI, EpSS, BDI-II, and BAI scores improved significantly. Patients without post-reconstruction depressive symptomatology were 13 times more likely to achieve clinically meaningful improvements in PSQI scores. The snore index significantly decreased in patients without post-reconstruction anxious symptomatology, while other PSG parameters did not show significant changes following reconstruction.

Reconstructive surgery significantly alleviates subjective symptoms in ENS patients, while psychiatric status plays a pivotal role in determining sleep outcomes. These findings highlight the importance of a comprehensive treatment approach that integrates both nasal function restoration and psychiatric care for optimizing surgical outcomes in ENS patients.