Osman Cerlet

Ankara Bilkent City Hsopital, Department of Otorhinolaryngology, Ankara, Türkiye

Cerlet O. The Role of Nasal Surgery in Obstructive Sleep Apnea (OSA). In: Özcan KM, editor. Sleep-Disordered Breathing: Diagnosis and Treatment. 1^st ed. Ankara: Türkiye Klinikleri; 2025. p.139-144.

ABSTRACT

Sleep apnea, particularly the obstructive type (OSA), is a disorder that occurs due to obstructions in the upper airway and can lead to serious health problems. Anatomical factors that cause upper airway stenosis play a significant role in the pathophysiology of OSA. Identifying the contributing factors and selecting the appropriate treatment for each patient is crucial for success. Anatomical abnormalities can occur at various levels within the upper airway. The presence of a pathology causing narrowing in the oropharynx or the base of the tongue should also be evaluated by an otolaryngologist. Common pathologies that cause narrowing in the nasal cavity include septal deviation, turbinate hypertrophy, and nasal valve problems. Other less common pathologies that impair nasal airflow include choanal atresia, synechiae, benign or malignant tumors in the nose and paranasal sinuses, and nasal polyps. The nasal cavity is a significant point of resistance for airflow in the upper airway. With nasal obstruction, inspiratory effort increases and causes multiple narrowings in the lower parts of the upper airway. If a deviated septum, a common nasal pathology, causes narrowing in the nasal passages, surgery may be performed. Septoplasty relieves the stenosis caused by deviated cartilage and bone. Septoplasty can be performed in the same session as other nasal surgeries. Surgery for turbinate hypertrophy is often performed in conjunction with other nasal surgeries. The most common surgeries for turbinate hypertrophy are turbinate lateralization and radiofrequency turbinate reduction. Turbinate lateralization involves first fracturing the medially located inferior turbinates medially and then laterally retracting them. Radiofrequency, which has become increasingly common in recent years, is applied to the turbinate using electrodes without damaging the mucosa. The goal is to induce contraction and fibrosis in the submucosal tissue of the turbinate. Aggressive turbinectomy techniques that damage the mucosa are not preferred. Surgery is also indicated for patients with static and dynamic stenosis in the nasal valve region. Nasal surgery can be performed alone or as part of a multilevel procedure involving sleep surgery in other regions. Nasal surgery alone plays an important role in alleviating sleep apnea symptoms and improving treatment compliance. However, in OSA cases that result from multiple contributing factors, the benefit of nasal surgery remains limited. Nasal surgeries have been shown to increase compliance with positive airway pressure therapy and therefore remain important.

Keywords: Functional nasal surgery; Obstructive sleep apnea; Continuous positive airway pressure; Nasal septum; Turbinates