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Published online before print September 26, 2007
Eur Respir J 2007, doi:10.1183/09031936.00087607
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ORIGINAL ARTICLE

Randomized trial of nasal surgery for fixed nasal obstruction in obstructive sleep apnoea

I. Koutsourelakis 1, G. Georgoulopoulos 2, E. Perraki 1, E. Vagiakis 1, C. Roussos 1, S.G. Zakynthinos 1*

1 Center of Sleep Disorders, Medical School of Athens University, Dept of Critical Care and Pulmonary Services, Evangelismos Hospital
2 Ear Nose Throat Dept, Evangelismos Hospital

* To whom correspondence should be addressed. E-mail: szakynthinos{at}yahoo.com.


  Abstract

Although nasal surgery has limited efficacy in obstructive sleep apnoea treatment, some patients experience improvement. This study tested the hypothesis that post-surgery improvement is associated with increased nasal breathing epochs.

Forty-nine OSA patients [mean apnoea-hypopnoea index (AHI) 30.1±16.3 events·h-1] with symptomatic fixed nasal obstruction due to deviated septum were randomly assigned to either septoplasty (surgery group; 27 patients) or sham surgery (placebo group; 22 patients). Breathing route was examined during overnight polysomnography.

Patients of the placebo group were non-responders, whereas in the surgery group, 4 patients were responders (14.8%) and exhibited considerable increase of nasal breathing epochs (epochs containing ≥3 consecutive phasic nasal signals), and 23 patients were non-responders presenting modest increase of nasal breathing epochs (p<0.001). The change in AHI was inversely related to the change in nasal breathing epochs (R2=0.775; p<0.001); responders exhibited among the greatest increases in nasal breathing epochs. Baseline nasal breathing epochs were positively related to percent change in AHI (R2=0.610; p<0.001). Responders had among the lowest baseline nasal breathing epochs; a cut-off value of 62.4% of total sleep epochs best separated (100% sensitivity, 82.6% specificity) responders/non-responders.

Nasal surgery rarely effectively treats obstructive sleep apnoea. Baseline nasal breathing epochs can predict the surgery outcome.

Keywords:  Apnoea-hypopnoea index, nasal breathing epochs, nasal surgery, obstructive sleep apnoea




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