The role of nasal obstruction and nasal surgery in the pathogenesis and treatment of obstructive sleep apnea and snoring

An obstructed nasal airway is known to be a potential contributing factor in the development of obstructive sleep apnea (OSA). Correction of an obstructed nasal airway should, therefore, logically improve OSA. Review of experimental data, however, indicates that correction of an obstructed nasal airway often does not improve objective data measuring the severity of OSA. In fact, an improved airway often results in worsening the OSA. This article reviews data on the effects of nasal surgery in comparing polysomnograms before and after surgery. It also reviews the effects of an improved nasal airway on continuous positive airway pressure (CPAP) levels and compliance rate of CPAP use. Most patients report an improvement in nasal and sleep symptoms after correction of a nasal airway obstruction; however, nasal surgery alone does not consistently improve OSA when measured objectively. Depending upon the severity of OSA, nasal airway reconstruction may contribute to a decrease in CPAP level and improvement in oxygen saturation. Correction of the obstructed nasal airway should be included in the overall management of OSA.