Effect Of Nasal Surgery On QOL For OSAS Patients | 12424
Otolaryngology: Open Access
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Effectiveness of nasal surgery on OSAS
Nasal airway patency plays a critical role in pathogenesis of obstructive sleep apnea syndrome (OSAS). Recent studies have shown that
nasal obstruction is an independent risk factor for OSAS and that its surgical correction generally has a positive impact on OSAS and its
related symptoms. However, the beneficial effects of nasal surgery in OSAS patients suffering from nasal obstruction have not been fully
investigated. For example, Verse and Pirsig summarized the effects of nasal surgery for OSAS 1) and they found a success rate of only 17.5%
for nasal surgery in 76 OSAS patients. Hence, nasal surgery is likely to decrease nasal obstruction and improve daytime sleepiness and
feelings of unrefreshed sleep, but it is not efficient enough to ameliorate OSAS.
Effect of nasal obstruction and nasal surgery for QOL
Regarding the inconsistent effects of nasal surgery on OSAS, a possibility that the direct benefits of nasal surgery is believed to be limited.
However, It was found that nasal surgery ameliorated sleep apnea reflected with the improved nocturnal oxygenation/sleep quality and
the shortened apnea duration2). Udaka et al. analyzed the relationship between daytime sleepiness and nasal obstruction with a large
questionnaire survey in a working population3). They revealed that the 7180 employees in post offices with complaints of severe nasal
obstruction experienced the symptom of a excessive daytime sleepiness, suggesting that chronic nasal obstruction should impair their
quality of daily life. Moreover, in many studies, the close cause�result relationship between daytime sleepiness and an occurrence of severe
allergic rhinitis have been clarified4)-5). Also, it was reported that rhinitis with symptomatic nasal obstruction was very often associated
with increased systolic blood pressure and it may be a risk for hypertension6). Regarding the impact of nasal surgery on subjective symptoms
and severity of obstructive events in OSAS, Se ́rie`s�s et al. also reported that the major effect of nasal surgery was symptom relief, without
lowering the occurrence of obstructive events7). Concerning an arousal, a study reported that frequent arousals due to evaluated upper
airway resistance and subsequent disrupted sleep architecture might be responsible for daytime hypersomnolence in OSAS 8). All of these
studies suggested that the disrupted sleep due to easy arousability, which could be predisposed by the elevated upper airway and nasal
resistance, is one of the important factors that explains the mechanism of a positive impact of nasal surgery on sleep quality and daytime
sleepiness in patients with OSAS. Although the pathogenesis to link a nasal airway patency to sleep quality has been mostly unknown to
date, the mechanoreceptors located in the nasal cavity should control the afferent/efferent stimuli from the nose to brain and vice versa.
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