Impact of Nasal Obstruction on Obstructive Sleep Apnea

Friedman, Michael; Maley, Alexander; Kelley, Kanwar; Leesman, Chris; Patel, Akshay; Pulver, Tanya; Joseph, Ninos J.; Çatlı, Tolgahan

doi:10.1177/0194599811400977

Cited by 57 publications

(47 citation statements)

References 23 publications

(59 reference statements)

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“…8 This may be due to increased likelihood of mouth breathing, which is associated with a higher upper airway resistance as compared with nasal breathing (5.65 cm H 2 O/L/s with nasal breathing vs 14.9 cm H 2 O/L/s, P = .005). 8 Similarly, if the nasal bones were broken, as occurs when osteotomy is performed in rhinoplasty, postoperative use of a CPAP mask that involves the nose (eg, nasal mask, nasal pillows, full-face mask) may be contraindicated, as it may affect the healing process. Therefore, it would be advisable to coordinate the care of such patients with their sleep specialists to discuss alternative mask options, such as switching to different mask options (eg, an oral interface or total face mask options), or alternative treatment options (eg, positional therapy, an oral appliance device, hypoglossal nerve stimulator).…”

Section: Supporting Textmentioning

confidence: 99%

Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty

Ishii

Tollefson

Basura

et al. 2017

Otolaryngol.--head neck surg.

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Objective. Rhinoplasty, a surgical procedure that alters the shape or appearance of the nose while preserving or enhancing the nasal airway, ranks among the most commonly performed cosmetic procedures in the United States, with >200,000 procedures reported in 2014. While it is difficult to calculate the exact economic burden incurred by rhinoplasty patients following surgery with or without complications, the average rhinoplasty procedure typically exceeds $4000. The costs incurred due to complications, infections, or revision surgery may include the cost of long-term antibiotics, hospitalization, or lost revenue from hours/days of missed work.The resultant psychological impact of rhinoplasty can also be significant. Furthermore, the health care burden from psychological pressures of nasal deformities/aesthetic shortcomings, surgical infections, surgical pain, side effects from antibiotics, and nasal packing materials must also be considered for these patients. Prior to this guideline, limited literature existed on standard care considerations for pre-and postsurgical management and for standard surgical practice to ensure optimal outcomes for patients undergoing rhinoplasty. The impetus for this guideline is to utilize current evidence-based medicine practices and data to build unanimity regarding the peri-and postoperative strategies to maximize patient safety and to optimize surgical results for patients.Purpose. The primary purpose of this guideline is to provide evidence-based recommendations for clinicians who either perform rhinoplasty or are involved in the care of a rhinoplasty candidate, as well as to optimize patient care, promote effective diagnosis and therapy, and reduce harmful or unnecessary variations in care. The target audience is any clinician or individual, in any setting, involved in the management of these patients. The target patient population is all patients aged ≥15 years. The guideline is intended to focus on knowledge gaps, practice variations, and clinical concerns associated with this surgical procedure; it is not intended to be a comprehensive reference for improving nasal form and function after rhinoplasty. Recommendations in this guideline concerning education and counseling to the patient are also intended to include the caregiver if the patient is <18 years of age.Action Statements. The Guideline Development Group made the following recommendations: (1) Clinicians should ask all patients seeking rhinoplasty about their motivations for surgery and their expectations for outcomes, should provide feedback on whether those expectations are a realistic goal of surgery, and should document this discussion in the medical record. (2) Clinicians should assess rhinoplasty candidates for comorbid conditions that could modify or contraindicate surgery, including obstructive sleep apnea, body dysmorphic disorder, bleeding disorders, or chronic use of topical vasoconstrictive intranasal drugs. (3) The surgeon, or the surgeon's designee, should evaluate the rhinoplasty candidate for...

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Section: Supporting Textmentioning

confidence: 99%

Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty

Ishii

Tollefson

Basura

et al. 2017

Otolaryngol.--head neck surg.

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“…Therefore, it is not surprising that our results suggest that children with palatal involvement (CP and CL+P) present more frequently with symptoms of OSA. Lastly, nasal airway obstruction, which may be present in patients with CL+P [11], may predispose to airway collapse and OSA [12,13].…”

Section: Primary Anatomic Osamentioning

confidence: 99%

“…Multiple studies have shown an association of nasal airway obstruction with OSA. Specifically, OSA has been noted to be twice as prevalent in patients with nasal airway obstruction [12]. Increased nasal airway resistance creates proportionately increased negative pressure in the pharynx, predisposing to collapsibility of the pharyngeal cavity and likely contributing to the pathogenesis of OSA [13].…”

Section: Patient Evaluation and Managementmentioning

confidence: 99%

Obstructive sleep apnea in children with cleft lip and/or palate: Results of an epidemiologic study

Carlson¹,

Sobol²,

Pien³

et al. 2017

Dent Oral Craniofac Res

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Introduction: Children with cleft lip and/or palate are at increased risk of obstructive sleep apnea. The prevalence of obstructive sleep apnea in this population is unknown. The purpose of this study was to assess the frequency of obstructive symptoms and obstructive sleep apnea diagnosis in the cleft population. We hypothesized that obstructive symptoms present more frequently in children with orofacial clefts than unaffected children, and that frequency varies by cleft sub-type.

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“…No presente estudo, foi encontrada relação estatisticamente significante entre os graus de apneia com a presença de obstrução nasal, com a intensidade do ronco e a Escala de sonolência de Epworth, quando comparados ao grupo com Ronco Primário, resultado este discordante com os da literatura (16) . Conforme referido anteriormente, embora o sítio primário de colapso nos pacientes com SAOS seja a parte oral da faringe e a parte laríngea da faringe, estudos demonstram uma significativa associação entre a obstrução nasal e a SAOS (8)(9)(10) , o que foi confirmado no presente estudo. Além do simples efeito da obstrução nasal no padrão de respiração durante o sono, o nariz é o maior condutor de ar para tratamento da SAOS com o aparelho de Pressão Positiva Contínua nas Vias Aéreas (CPAP).…”

Section: Grupo I -Com Saos (142 Pacientes -73%)unclassified

“…Doenças inflamatórias da mucosa do nariz, ou alterações estruturais, como desvio de septo nasal, hipertrofia das conchas, lesões traumáticas, lesões neoplásicas, pólipos, colapso da válvula nasal, hipertrofia de adenoides e corpos estranhos, podem ser as principais causas de obstrução nasal (6) . Embora o sítio primário de colapso nos pacientes com SAOS seja a parte oral da faringe e a parte laríngea da faringe, estudos demonstram uma significativa associação entre a obstrução nasal e a SAOS (8)(9)(10) . Este estudo tem como objetivo verificar a associação de obstrução nasal em pacientes com queixas de distúrbios respiratórios relacionados ao sono, encaminhados a um Ambulatório de Ronco e Apneia de Sono.…”

Section: Introductionunclassified

Prevalência De Obstrução Nasal Em Pacientes Com Distúrbios Respiratórios Relacionados Ao Sono

Bortoluzzi¹,

Oliveira

Abdo

et al. 2016

ACS

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Conflito de interesses:Não Contribuição dos autores: TBB concepção e planejamento do projeto de pesquisa, obtenção ou análise/interpretação dos dados, redação e revisão crítica. ACO concepção e planejamento do projeto de pesquisa, obtenção ou análise/interpretação dos dados, redação e revisão crítica. YCVA concepção e planejamento do projeto de pesquisa, obtenção ou análise/interpretação dos dados, redação e revisão crítica. ICAS concepção e planejamento do projeto de pesquisa, obtenção ou análise/interpretação dos dados, redação e revisão crítica. VBP concepção e planejamento do projeto de pesquisa, obtenção ou análise/interpretação dos dados, redação e revisão crítica. FDM concepção e planejamento do projeto de pesquisa, obtenção ou análise/interpretação dos dados, redação e revisão crítica. Resultados: A amostra foi constituída de 133 (68%) pacientes do gênero masculino e 62 (32%) do feminino. Dentre os pacientes com síndrome da apneia obstrutiva do sono (Grupo I), 76% são homens, média de 48,5 anos (DP ± 10,7 anos), obesos e índice de apneia/hipopneia grave. Os pacientes com ronco primário (Grupo II) são mulheres (53%), média de 45,7 anos (DP ± 10,2 anos) e com sobrepeso. O desvio de septo nasal e hipertrofia de conchas foram as alterações nasais mais prevalentes para ambos os grupos. A comparação dos pacientes do Grupo I apresentando obstrução nasal, com a intensidade do ronco e com o grau de sonolência em relação ao Grupo II foi significante (p=0,008). Conclusão: Os pacientes com síndrome da apneia obstrutiva do sono são homens de meia idade, obesos e com apneia grave. Aqueles com ronco primário são mulheres na meia idade e com sobrepeso. Houve associação da presença de obstrução nasal com a síndrome da apneia obstrutiva do sono, com os graus de apneia, com a intensidade do ronco e com maior sonolência. Contato para correspondência:Descritores: Síndromes da Apneia do Sono; Obstrução Nasal; Ronco. AbstractIntroduction: There is a relationship between the clinical history of nasal obstruction, snoring, and obstructive sleep apnea, due to increased nasal resistance. Objective: Determine the association of nasal obstruction in patients with sleep-related respiratory disorders. Material and Methods: From January 2013 to December 2014, we analyzed 195 medical records of patients treated by the Service of Otorhinolaryngology. We carried out a retrospective cross-sectional case study. Results: There were 133 (68%) men and 62 (32%) women. Of the patients with obstructive sleep apnea (Group I), 76% are male, mean age of 48.5 years (SD ± 10.7 years), obese, and severe apnea-hypopnea index. Patients with primary snoring (Group II) are female (53%), mean age of 45.7 years (SD ± 10.2 years), and with overweight. Nasal septum deviation and nasal conchae hypertrophy were the most prevalent disorders for both groups. We found a statistically significant difference (p = 0.008) regarding the nasal obstruction with the intensity of snoring and the degree of somnolence when comparing patients of both groups. Conclusion: Patien...

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Impact of Nasal Obstruction on Obstructive Sleep Apnea

Abstract: Postoperative nasal packing aggravated measures of OSA in patients with mild OSA but not in patients with moderate/severe OSA.

Cited by 57 publications

References 23 publications

Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty

Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty

Obstructive sleep apnea in children with cleft lip and/or palate: Results of an epidemiologic study

Prevalência De Obstrução Nasal Em Pacientes Com Distúrbios Respiratórios Relacionados Ao Sono

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