Park Do-Yang, Cho Jae Hoon, Jung Yong Gi, Choi Ji Ho, Kim Dong-Kyu, Kim Sang-Wook, Kim Hyun Jun, Kim Hyo Yeol, Park Soo Kyoung, Park Chan Soon, Yang Hyung Chae, Lee Seung Hoon, Cho Hyung-Ju
Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University School of Medicine, Seoul, Korea.
Clin Exp Otorhinolaryngol. 2023 Aug;16(3):201-216. doi: 10.21053/ceo.2022.01361. Epub 2023 Feb 15.
Obstructive sleep apnea (OSA) is a common disorder characterized by upper airway obstruction during sleep. To reduce the morbidity of OSA, sleep specialists have explored various methods of managing the condition, including manifold positive airway pressure (PAP) techniques and surgical procedures. Nasal obstruction can cause significant discomfort during sleep, and it is likely that improving nasal obstruction would enhance the quality of life and PAP compliance of OSA patients. Many reliable studies have offered evidence to support this assumption. However, few comprehensive guidelines for managing OSA through nasal surgery encompass all this evidence. In order to address this gap, the Korean Society of Otorhinolaryngology-Head and Neck Surgery (KORL-HNS) and the Korean Society of Sleep and Breathing designated a guideline development group (GDG) to develop recommendations for nasal surgery in OSA patients. Several databases, including OVID Medline, Embase, the Cochrane Library, and KoreaMed, were searched to identify all relevant papers using a predefined search strategy. The types of nasal surgery included septoplasty, turbinate surgery, nasal valve surgery, septorhinoplasty, and endoscopic sinus surgery. When insufficient evidence was found, the GDG sought expert opinions and attempted to fill the evidence gap. Evidence-based recommendations for practice were ranked according to the American College of Physicians' grading system. The GDG developed 10 key action statements with supporting text to support them. Three statements are ranked as strong recommendations, three are only recommendations, and four can be considered options. The GDG hopes that this clinical practice guideline will help physicians make optimal decisions when caring for OSA patients. Conversely, the statements in this guideline are not intended to limit or restrict physicians' care based on their experience and assessment of individual patients.
阻塞性睡眠呼吸暂停（OSA）是一种常见的疾病，其特征是睡眠期间上呼吸道阻塞。为了降低OSA的发病率，睡眠专家探索了多种治疗该疾病的方法，包括多种持续气道正压通气（PAP）技术和外科手术。鼻阻塞可在睡眠期间引起明显不适，改善鼻阻塞可能会提高OSA患者的生活质量和PAP依从性。许多可靠的研究已提供证据支持这一假设。然而，很少有通过鼻手术治疗OSA的综合指南涵盖所有这些证据。为了填补这一空白，韩国耳鼻咽喉头颈外科学会（KORL-HNS）和韩国睡眠与呼吸学会指定了一个指南制定小组（GDG），以制定OSA患者鼻手术的建议。使用预定义的搜索策略，检索了包括OVID Medline、Embase、Cochrane图书馆和KoreaMed在内的多个数据库，以识别所有相关论文。鼻手术的类型包括鼻中隔成形术、鼻甲手术、鼻瓣膜手术、鼻整形术和鼻内镜鼻窦手术。当发现证据不足时，GDG征求专家意见，并试图填补证据空白。基于证据的实践建议根据美国医师学会的分级系统进行排名。GDG制定了10条关键行动声明，并配有支持性文本。其中三条声明被列为强烈推荐，三条仅为推荐，四条可视为可选方案。GDG希望本临床实践指南将有助于医生在治疗OSA患者时做出最佳决策。相反，本指南中的声明并非旨在根据医生对个体患者的经验和评估来限制或约束他们的治疗。
