The Effect of Nasal Surgery on Continuous Positive Airway Pressure Device Use and Therapeutic Treatment Pressures: A Systematic Review and Meta-Analysis

Camacho, Macario; Riaz, Muhammad Bilal; Capasso, Robson; Ruoff, Chad; Guilleminault, Christian; Kushida, Clete A.; Certal, Victor

doi:10.5665/sleep.4414

Cited by 134 publications

(104 citation statements)

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“…For example, nasal dilators may reduce the pressure required for continuous positive airway pressure (CPAP) devices [32]. Since lower CPAP treatment pressures often improve CPAP use [8], it is possible that nasal dilator use may also improve CPAP use. In those patients with significant improvement in breathing with nasal dilators but who cannot tolerate the devices, site directed nasal surgery may be considered.…”

Section: Discussionmentioning

confidence: 99%

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Nasal Dilators (Breathe Right Strips and NoZovent) for Snoring and OSA: A Systematic Review and Meta-Analysis

et al. 2016

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Objective. To systematically review the international literature for studies evaluating internal (NoZovent) and external (Breathe Right Strips) nasal dilators as treatment for obstructive sleep apnea (OSA). Study Design. Systematic review with meta-analysis. Methods. Four databases, including PubMed/MEDLINE, were searched through September 29, 2016. Results. One-hundred twelve studies were screened, fifty-eight studies were reviewed, and fourteen studies met criteria. In 147 patients, the apnea-hypopnea index (AHI) was reported, and there was an improvement from a mean ± standard deviation (M ± SD) of 28.7 ± 24.0 to 27.4 ± 23.3 events/hr, p value 0.64. There was no significant change in AHI, lowest oxygen saturation, or snoring index in OSA patients when using nasal dilators. However, a subanalysis demonstrated a slight reduction in apnea index (AI) with internal nasal dilators (decrease by 4.87 events/hr) versus minimal change for external nasal dilators (increase by 0.64 events/hr). Conclusion. Although nasal dilators have demonstrated improved nasal breathing, they have not shown improvement in obstructive sleep apnea outcomes, with the exception of mild improvement in apnea index when internal nasal dilators were used.

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Section: Discussionmentioning

confidence: 99%

“…There are many treatments for OSA, to include medical management with positive airway pressure devices [4], oral appliances, and myofunctional therapy [5]. Nasal therapies to help treat OSA include nasopharyngeal airway stenting devices [6], nasal expiratory positive airway pressure devices (Provent) [7], and nasal surgery [8, 9]. …”

Section: Introductionmentioning

confidence: 99%

Nasal Dilators (Breathe Right Strips and NoZovent) for Snoring and OSA: A Systematic Review and Meta-Analysis

et al. 2016

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“…A meta-analysis of 18 articles with 279 patients concluded that the mean CPAP requirement decreased postoperatively (11.6 ± 2.2 to 9.5 ± 2.0 cm H 2 O, P < .00001) and that 89% of patients who were not using CPAP regularly subsequently accepted or adhered to CPAP use after their nasal surgery. 88 During the immediate postoperative period, nasal packing-if it is used (since routine nasal packing is not recommended-see key action statement 9-can worsen upper airway resistance and complicate the management of OSA. Friedman et al demonstrated that, among patients with mild OSA, the AHI significantly increased with nasal packing.…”

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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“…A large proportion of these were investigations of different modalities and treatment arms for pediatric tonsillectomy (pediatric studies made up 32.2% of all surgical studies). This relative lack of clinical trials exploring surgical treatments of adult OSA is concerning, especially with increasing literature demonstrating the benefit of surgical therapy for OSA . In the future, it is important that surgical options remain an available and investigated part of OSA management.…”

Section: Discussionmentioning

confidence: 99%

“…This relative lack of clinical trials exploring surgical treatments of adult OSA is concerning, especially with increasing literature demonstrating the benefit of surgical therapy for OSA. 5,18,19 In the future, it is important that surgical options remain an available and investigated part of OSA management. This finding of a minor role for ear, nose, and throat specialists in sleep apnea research is consistent with several prior recent studies expressing concern about the diminishing role of our specialty in OSA care.…”

Section: Discussionmentioning

confidence: 99%

Clinical Trials in Obstructive Sleep Apnea: Recognizing Trends and Future Opportunities

Singh

Capasso

et al. 2018

The Laryngoscope

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Objectives/Hypothesis Examine US and international clinical trials in obstructive sleep apnea (OSA) to characterize researchers involved, interventions being studied, and opportunities for future investigation. Study Design Retrospective database review. Methods The information from ClinicalTrials.gov was used to assess OSA clinical trials between 1999 and 2017. Information was gathered on principle investigator (PI) demographics, interventions studied, study funding source, and regional distribution of research institutions. Results There were 813 clinical trials studied. The majority of trials examined continuous positive airway pressure interventions (43.7%), with pharmacotherapies being the second most commonly investigated treatment (19.2%). Surgical interventions made up 10.7% (n = 87) of clinical trials for OSA. Most studies were based internationally (59.9%). PIs were predominantly male (72.0%); 72.7% had an MD and 28.6% had a PhD. There were no significant differences in funding source (National Institutes of Health vs. industry, P = .14) or institutional geography (international vs. US, P = .73) between surgical and nonsurgical studies. Surgical trials were significantly more likely to have a male PI and involve pediatric patients compared to nonsurgical trials (P < .001). Otolaryngologists represented 9.2% of all PIs and had similar rates of NIH funding compared to other medical specialists (P = .22). Conclusions This study provides a broad overview of past, current, and future treatment paradigms for OSA. Sleep surgery, specifically otolaryngology, is a small voice in the overall landscape of clinical trials for OSA. This information can help guide future research efforts and direct our specialty when setting priorities regarding research funding while encouraging a broad and interdisciplinary pursuit. Level of Evidence NA Laryngoscope, 129:1940–1944, 2019

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The Effect of Nasal Surgery on Continuous Positive Airway Pressure Device Use and Therapeutic Treatment Pressures: A Systematic Review and Meta-Analysis

Abstract: Isolated nasal surgery in patients with OSA and nasal obstruction reduces therapeutic CPAP device pressures and the currently published literature's objective and subjective data consistently suggest that it also increases CPAP use in select patients.

Cited by 134 publications

References 45 publications

Nasal Dilators (Breathe Right Strips and NoZovent) for Snoring and OSA: A Systematic Review and Meta-Analysis

Nasal Dilators (Breathe Right Strips and NoZovent) for Snoring and OSA: A Systematic Review and Meta-Analysis

Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty

Clinical Trials in Obstructive Sleep Apnea: Recognizing Trends and Future Opportunities

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