Can nasal surgery help CPAP therapy?

Written by David Volpi, M.D., P.C., F.A.C.S.

This month’s blog is for anyone who has obstructive sleep apnea (OSA) and is having trouble using—or refusing to use—a Continuous Positive Airway Pressure (CPAP) machine while sleeping.

CPAP machines help nighttime interrupted breathing by pumping a continuous flow of air into the nasal passages, keeping the airway open, and preventing or greatly reducing snoring and paused breathing. Still, many people are uncomfortable wearing the CPAP mask at night. Some feel claustrophobic or claim it causes dry mouth, nasal congestion and/or skin irritations.

There are two points I want to make about CPAP machines. One is: realize there are different types of masks and machines available, so take the time to choose one that’s right for you. Choose a small, quiet machine with a comfortable mask that fits you well. A heated humidifier attached to the CPAP machine can reduce throat dryness. Also, adjust titration so the CPAP pressure isn’t too high.

The second point I want to make, is that for some patients with nasal obstruction, a nasal surgery called septoplasty may help make CPAP therapy easier when combined with the above suggestions. An article in the January 2014 issue of The Laryngoscope  explains this first-of-its-kind study.

In response to the difficulty many OSA patients have using CPAP—what doctors call “problematic nonadherence”—three researchers wanted to find out if septoplasty, a surgery for nasal obstruction, would improve CPAP use and effectiveness.

For the study, head researchers Justin Poirier MD, Charles George MD, FRCPC, and Brian Rotenberg MD, MPH studied 18 patients over a six month period. Their average age was 52, 15 were males, and three were female. All the participants had been diagnosed with OSA, were prescribed nasal CPAP, yet were unable to tolerate CPAP treatment mostly due to nasal obstruction and a deviated septum.

The patients underwent septoplasty surgery with inferior turbinoplasty to improve breathing and sinus drainage. Following the surgery, data was collected regarding the patients’ CPAP usage per night. Patients were also asked to fill out the Nasal Obstruction Symptom Evaluation (NOSE) Scale questionnaire on how their post-surgery nasal obstruction felt.

The results of the study were encouraging. Before surgery, average patient CPAP usage was 0.5 hours per night. Pre-surgery NOSE Scale questionnaire data averaged 16.1 among the patients, with a maximum possible score of 20.

After surgery, the mean nightly CPAP usage was 3.9 hours per night (significant difference compared to preoperative data at P < .05). And the NOSE Scale score decreased to 5.4 (significant difference compared to preoperative data at P < .05).

In summary, the results show improved CPAP compliance rates following septoplasty surgery in OSA patients with documented nasal obstruction. That said, it’s important to keep in mind that septopasty surgery should be considered conservatively and for appropriate patients. Nasal surgery is not a cure-all for OSA, but along with CPAP and/or other therapies, could make a positive difference in easing OSA-related symptoms. Further, the results of this study offers some written proof of the effectiveness of septoplasty surgery for nasal obstruction and OSA treatment.

If you have been diagnosed with OSA, or are suffering from snoring and sleep issues, I urge you to get evaluated by a qualified ear, nose, and throat doctor. Some common symptoms of OSA include snoring, paused breathing during sleep and excessive sleepiness during the day. Increased blood pressure is another sign you may have sleep apnea.

Untreated OSA can result in poor sleep (for you and your partner), lack of focus, increased cardiovascular disease, and even death. So please get checked out. There are multiple options and minimally invasive techniques available today to treat OSA and other sleep disorders.

Read the full article entitled, “The effect of nasal surgery on nasal continuous positive airway pressure compliance” in the January 2014 issue of The Laryngoscope.