The Role of Nasal Surgery in the Treatment of OSA

Abstract

Obstructive sleep apnea (OSA) is the collapse of the upper airway during sleep. The airway in the sleep state is very different from the airway in the awake state. The tissues that are collapsing very often can be identified and treated surgically by the current reconstructive techniques that are available. We know that it is not a “level” that obstructs, but a particular anatomy that is obstructing. The “palate level” can be due to large tonsils, thick redundant palate, long thick uvula, and/or collapsing lateral pharyngeal walls. Hence, it is not enough to say that the “level of the palate” is obstructing. Similarly, the nasal pathologies should also be described in detail, as in septal deviation, turbinate hypertrophy and/or nasal polyposis. Most sleep surgeons recognise that the treatment of the nose in OSA is pivotal, but not primary. This means that surgery to the nose as a single operative site has minimal effect on sleep apnea parameters, with low success rates. However, nasal surgery is of great importance in the surgical armamentarium of OSA due to its ability to facilitate other OSA treatments and maximize patient quality of life.