The Role of Inverted Papilloma Surgical Removal for Sleep Apnea Treatment Success—A Case Report

Abstract

In recent years, increased attention has been directed to sleep apnea syndrome due to its high prevalence and preventable severe health consequences. Besides enhancing the risk of cardiovascular, cerebrovascular, and metabolic disorders, it determines increased daytime somnolence, cognitive impairment, and delayed reaction time. These symptoms, determined by sleep fragmentation and chronic hypoxemia, can result in a decrease in professional performance and, moreover, could have tragic implications, especially in patients with high-risk professions. We present the case of a 58-year-old male-truck driver, known to suffer from uncontrolled OSA and chronic obstructive pulmonary disease, who presented to our ENT department for incapacitating daytime somnolence and severe nasal obstruction. These symptoms were caused by a voluminous sinonasal inverted papilloma, occupying the entire left cavity with extension in the nasopharynx. Following nose permeabilization, the patients’ APAP compliance grew substantially, with a dramatic decrease in daytime sleepiness and improvement in polysomnographic parameters. Due to the overlap syndrome of OSA and COPD, an oxygen supplementation was added to PAP therapy by a pulmonologist, improving pulse-oximetry parameters and resulting in the best outcome for the patient. Through this case report, we aim to emphasize the importance of multimodal, personalized treatment of sleep apnea with a focus on nasal surgical permeabilization. At the same time, we sustain a multidisciplinary approach, especially in patients with sleep apnea and associated pathologies, to obtain therapeutic success. We propose increased attention to the early recognition and proper treatment of sleep apnea in patients with high-risk professions as it prevents catastrophes.

Obstructive sleep apnea for the rhinologist

“…Although isolated nasal surgery alone has not been shown to correct AHI [27], multiple studies have demonstrated that nasal surgery can improve subjective measures nasal obstruction and improve CPAP use and effectiveness [28,29]. Sinonasal pathologies, such has nasal polyposis and inverted papilloma have been shown to negatively affect OSA and CPAP compliance necessitating adequate disease control in order to improve OSA [30][31][32]33 & ] Surgical correction of nasal obstruction often involves septoplasty, inferior turbinate reduction, and/or internal nasal valve repair. Additionally, in patients with chronic rhinosinusitis, endoscopic sinus surgery can improve mucosal inflammation causing nasal obstruction [34].…”