Department of Otorhinolaryngology and Sleep Medicine, Second Hospital, Fujita Health University, Nagoya, Aichi, Japan.
Department of Otorhinolaryngology and Sleep Medicine, Second Hospital, Fujita Health University, Nagoya, Aichi, Japan.
Auris Nasus Larynx. 2020 Dec;47(6):1018-1022. doi: 10.1016/j.anl.2020.06.005. Epub 2020 Jul 14.
The role of isolated nasal surgery for obstructive sleep apnea (OSA) patients with nasal obstruction, especially for an intolerance for continuous positive airway pressure (CPAP), is unclear. The aim of this study was to assess the effects of surgery for OSA patients with symptomatic nasal obstruction and CPAP intolerance.
Retrospectve comparative study.1037 OSA patients with apnea-hypopnea index (AHI) ≥ 20 were enrolled. Case-control study was performed between the male apnea patients undergoing nasal surgery: surgery group (n = 43) and the pair-matched apnea patients for age, sex, body mass index, and race: control group (n = 43). The surgery group suffering from nasal obstruction could not use continuous positive airway pressure, and the CPAP group free from nasal obstruction could use it successfully.
In surgery group, surgery significantly decreased the nasal resistance and Epworth sleepiness scale scores without changing the AHI. Surgery significantly increased the nadir of oxygen saturation and shortened the apnea-hypopnea duration. Although all of the surgery group failed to use positive airway pressure preoperatively, the 40 patients of the 43 CPAP intolerance patients were able to use CPAP postoperatively. The resting three patients were cured OSA or changed the treatment to oral appliance(OA). For both groups, the cutoff nasal resistance for differentiating the failure of positive airway pressure and its success was 0.31 Pa/cm/s.
Isolated nasal surgery is effective for an intolerance of positive airway pressure in sleep apnea with nasal obstruction presumably by decreasing nasal resistance.
孤立性鼻腔手术治疗阻塞性睡眠呼吸暂停（OSA）伴鼻腔阻塞患者，尤其是对持续气道正压通气（CPAP）不耐受患者的作用尚不清楚。本研究旨在评估手术治疗有症状性鼻腔阻塞和 CPAP 不耐受的 OSA 患者的效果。
回顾性对比研究。共纳入 1037 例 AHI≥20 的 OSA 患者。对行鼻腔手术的男性 OSA 患者（n=43）进行病例对照研究，与年龄、性别、体重指数和种族相匹配的 OSA 患者（n=43）进行配对对照。手术组因鼻腔阻塞不能使用 CPAP，CPAP 组因鼻腔阻塞能成功使用 CPAP。
手术组术后鼻腔阻力和 Epworth 嗜睡评分显著降低，而 AHI 无变化。手术组最低血氧饱和度显著升高，呼吸暂停-低通气时间缩短。尽管所有手术组患者术前均不能使用 CPAP，但 43 例 CPAP 不耐受患者中的 40 例术后能够使用 CPAP。3 例静息患者 OSA 治愈或改为口腔矫治器（OA）治疗。对于两组患者，区分 CPAP 失败和成功的临界鼻腔阻力为 0.31 Pa/cm/s。
孤立性鼻腔手术通过降低鼻腔阻力，对 OSA 伴鼻腔阻塞患者 CPAP 不耐受有效。
