Surgical correction of nasal obstruction in obstructive sleep apnea improves CPAP outcomes and compliance
Abstract
Background Although continuous positive airway pressure (CPAP) therapy curtails most of the negative impacts of obstructive sleep apnea (OSA), its efficacy is limited by its low long-term adherence. Nasal obstruction contributes to OSA pathophysiology and necessitates high CPAP titration pressures which reduce CPAP compliance.Aim This study aims at elucidating the outcomes of surgical correction of nasal obstruction in patients intolerant to CPAP therapy.Methods Forty-nine patients with severe OSA intolerant to CPAP secondary to surgically correctable nasal obstruction were operated upon. Patients were evaluated preoperatively and at least 3 months after the surgical intervention. Subjective assessment entailed the Nasal Obstruction Symptom Evaluation score (NOSE) and the Epworth Sleepiness Scale (ESS). Objectively the patients were assessed by acoustic rhinometry and standard polysomnography.Results Nasal surgical intervention resulted in an a statistically significant decrease in the mean NOSE score, ESS and optimal CPAP titration pressure. In addition, the minimal cross-sectional area (MCA1&2) increased significantly postoperatively. There was a positive correlation between the improvement in NOSE score as well as the MCA1& 2 and the postoperative decrease in CPAP titration pressure. Surgical correction of nasal obstruction improved CPAP outcomes and compliance in all patients.Conclusions Nasal surgery in OSA objectively assessed by acoustic rhinometry improved nasal obstruction with a resultant decrease in the CPAP pressure requirements. Given that lower CPAP pressures improve adherence to CPAP therapy, surgical alleviation of nasal obstruction should be considered a crucial intervention in the management armamentarium of OSA.
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The overall AHI was not significantly different after nasal surgery in twelve studies.
“The overall AHI was not significantly different after nasal surgery in twelve studies [15,16,17,18,21,22,23,24,25,28,29,30].”
From The Role of Isolated Nasal Surgery in Obstructive Sleep Apnea Therapy—A Systematic Review (2022) · cites this paper as [28]
Three studies specifically evaluated the effect of nasal surgery in patients with CPAP intolerance.
“Three studies specifically evaluated the effect of nasal surgery in patients with CPAP intolerance [22,28,30].”
From The Role of Isolated Nasal Surgery in Obstructive Sleep Apnea Therapy—A Systematic Review (2022) · cites this paper as [28]
In the studies of patients with CPAP intolerance, almost all patients tolerated CPAP postoperatively.
“In these studies, almost all patients tolerated CPAP postoperatively.”
From The Role of Isolated Nasal Surgery in Obstructive Sleep Apnea Therapy—A Systematic Review (2022) · cites this paper as [28]
Bican et al. and Elwany et al. concluded that patients tolerated CPAP therapy better after nasal surgery.
“Bican et al. and Elwany et al. concluded that patients tolerated CPAP therapy better after nasal surgery [28,31].”
From The Role of Isolated Nasal Surgery in Obstructive Sleep Apnea Therapy—A Systematic Review (2022) · cites this paper as [28]
Bican et al. and Elwany et al. found a significant decrease in CPAP titration pressure after nasal surgery.
“They found a significant decrease in CPAP titration pressure after nasal surgery.”
From The Role of Isolated Nasal Surgery in Obstructive Sleep Apnea Therapy—A Systematic Review (2022) · cites this paper as [28]
Cites
A New Method for Measuring Daytime Sleepiness: The Epworth Sleepiness Scale
Johns, M. W. (1991) · Sleep · doi:10.1093/sleep/14.6.540 · Cited by 17,364 · see citing works
The epidemiology of adult obstructive sleep apnea
Punjabi, N. M. (2008) · Proceedings of the American Thoracic Society · doi:10.1513/pats.200709-155mg · Cited by 2,361 · see citing works
Adherence to Continuous Positive Airway Pressure Therapy: The Challenge to Effective Treatment
Weaver, T. E., & Grunstein, R. R. (2008) · Proceedings of the American Thoracic Society · doi:10.1513/pats.200708-119mg · Cited by 1,680 · see citing works
Objective Measurement of Patterns of Nasal CPAP Use by Patients with Obstructive Sleep Apnea
Kribbs, N. B., Pack, A. I., Kline, L. R., Smith, P. L., Schwartz, A. R., Schubert, N. M., Redline, S., Henry, J. N., Getsy, J. E., & Dinges, D. F. (1993) · American Review of Respiratory Disease · doi:10.1164/ajrccm/147.4.887 · Cited by 1,339 · see citing works
Development and Validation of the Nasal Obstruction Symptom Evaluation (NOSE) Scale1
Stewart, M. G., Witsell, D. L., Smith, T. L., Weaver, E. M., Yueh, B., & Hannley, M. (2004) · Otolaryngology · doi:10.1016/j.otohns.2003.09.016 · Cited by 1,221 · see citing works
Weaver, T. E., Maislin, G., Dinges, D. F., Bloxham, T., George, C. F. P., Greenberg, H., Kader, G., Mahowald, M., Younger, J., & Pack, A. I. (2007) · Sleep · doi:10.1093/sleep/30.6.711 · Cited by 1,058 · see citing works
Upper airway pressure-flow relationships in obstructive sleep apnea
Smith, P. L., Wise, R. A., Gold, A. R., Schwartz, A. R., & Permutt, S. (1988) · Journal of Applied Physiology · doi:10.1152/jappl.1988.64.2.789 · Cited by 446 · see citing works
Mouth Leak With Nasal Continuous Positive Airway Pressure Increases Nasal Airway Resistance
Richards, G. N., Cistulli, P. A., Ungar, R. G., Berthon-Jones, M., & Sullivan, C. E. (1996) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.154.1.8680678 · Cited by 279 · see citing works
Effect of improved nasal breathing on obstructive sleep apnea
Friedman, M., Tanyeri, H., Lim, J. W., Landsberg, R., Vaidyanathan, K., & Caldarelli, D. (2000) · Otolaryngology–Head and Neck Surgery · doi:10.1016/s0194-5998(00)70147-1 · Cited by 267 · see citing works
Krieger, J. (1992) · SLEEP · doi:10.1093/sleep/15.suppl_6.s42 · Cited by 184 · see citing works
Therapy with nCPAP: incomplete elimination of Sleep Related Breathing Disorder
Grote, L., Hedner, J. A., Grunstein, R. R., & Kraiczi, H. (2000) · European Respiratory Journal · doi:10.1183/09031936.00.16592100 · Cited by 184 · see citing works
Léger, D., & Stepnowsky, C. J. (2020) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2020.101275 · Cited by 175 · see citing works
Effect of Nasal Surgery on Sleep‐Related Breathing Disorders
Verse, T., Maurer, J. T., & Pirsig, W. (2002) · The Laryngoscope · doi:10.1097/00005537-200201000-00012 · Cited by 173 · see citing works
Camacho, M., Riaz, M., Capasso, R., Ruoff, C. M., Guilleminault, C., Kushida, C. A., & Certal, V. (2015) · Sleep · doi:10.5665/sleep.4414 · Cited by 164 · see citing works
Mouth Breathing Compromises Adherence to Nasal Continuous Positive Airway Pressure Therapy
Bachour, A., & Maasilta, P. K. (2004) · CHEST Journal · doi:10.1378/chest.126.4.1248 · Cited by 154 · see citing works
Obstructive Sleep Apnea, Cardiovascular Disease, and Pulmonary Hypertension
Golbin, J. M., Somers, V. K., & Caples, S. M. (2008) · Proceedings of the American Thoracic Society · doi:10.1513/pats.200708-143mg · Cited by 145 · see citing works
Does Nasal Surgery Improve OSA in Patients with Nasal Obstruction and OSA? A Meta‐analysis
Ishii, L., Roxbury, C., Godoy, A., Ishman, S., & Ishii, M. (2015) · Otolaryngology–Head and Neck Surgery · doi:10.1177/0194599815594374 · Cited by 127 · cited 2× · see citing works
“Although surgical correction of nasal obstruction was initially proposed as a treatment modality for OSA, several studies failed to demonstrate a consistent reduction in AHI post-operatively [11].”
MethodNasal vs Oronasal CPAP for OSA Treatment
Andrade, R. G. S., Viana, F. M., Nascimento, J. A., Drager, L. F., Moffa, A., Brunoni, A. R., Genta, P. R., & Lorenzi-Filho, G. (2018) · Chest · doi:10.1016/j.chest.2017.10.044 · Cited by 122 · see citing works
Effects of nasal surgery on sleep quality in obstructive sleep apnea syndrome with nasal obstruction
Nakata, S., Noda, A., Yasuma, F., Morinaga, M., Sugiura, M., Katayama, N., Sawaki, M., Teranishi, M., & Nakashima, T. (2008) · American Journal of Rhinology · doi:10.2500/ajr.2008.22.3120 · Cited by 104 · see citing works
Biomechanics of the upper airway: Changing concepts in the pathogenesis of obstructive sleep apnea
Susarla, S. M., Thomas, R. J., Abramson, Z. R., & Kaban, L. B. (2010) · International Journal of Oral and Maxillofacial Surgery · doi:10.1016/j.ijom.2010.09.007 · Cited by 99 · see citing works
The effect of nasal surgery on nasal continuous positive airway pressure compliance
Poirier, J., George, C. F., & Rotenberg, B. W. (2013) · The Laryngoscope · doi:10.1002/lary.24131 · Cited by 87 · see citing works
Li, H.-Y., Engleman, H., Hsu, C.-Y., Izci, B., Vennelle, M., Cross, M., & Douglas, N. J. (2005) · Sleep · doi:10.1093/sleep/28.12.1554 · Cited by 69 · see citing works
Acoustic rhinometry predicts tolerance of nasal continuous positive airway pressure: a pilot study
Morris, L. G., Setlur, J., Burschtin, O. E., Steward, D. L., Jacobs, J. B., & Lee, K. C. (2006) · American Journal of Rhinology · doi:10.1177/194589240602000202 · Cited by 64 · see citing works
The Problem of Nasal Obstruction
Kimmelman, C. P. (1989) · Otolaryngologic Clinics of North America · doi:10.1016/s0030-6665(20)31437-7 · Cited by 63 · see citing works
Nasal function and CPAP compliance
Inoue, A., Chiba, S., Matsuura, K., Osafune, H., Capasso, R., & Wada, K. (2019) · Auris Nasus Larynx · doi:10.1016/j.anl.2018.11.006 · Cited by 57 · see citing works
Zonato, A. I., Bittencourt, L., Martinho, F. L., Gregório, L. C., & Tufik, S. B. (2006) · European Archives of Oto-Rhino-Laryngology · doi:10.1007/s00405-005-1018-y · Cited by 56 · see citing works
Factors Contributing to Unintentional Leak During CPAP Treatment
Lebret, M., Martinot, J., Arnol, N., Zerillo, D., Tamisier, R., Pépin, J., & Borel, J. (2016) · CHEST Journal · doi:10.1016/j.chest.2016.11.049 · Cited by 56 · see citing works
The efficacy of nasal surgery in obstructive sleep apnea syndrome: A prospective clinical study
Sufioğlu, M., Ozmen, O. A., Kasapoglu, F., Demir, U. L., Ursavas, A., Erişen, L., & Onart, S. (2012) · European Archives of Oto-Rhino-Laryngology · doi:10.1007/s00405-011-1682-z · Cited by 52 · see citing works
What is the efficacy of nasal surgery in patients with obstructive sleep apnea syndrome?
Bican, A., Kahraman, A., Bora, İ., Kahveci, R., & Hakyemez, B. (2010) · Journal of Craniofacial Surgery · doi:10.1097/scs.0b013e3181f40551 · Cited by 48 · see citing works
Sopkova, Z., Dorková, Z., & Tkáčová, R. (2009) · Wiener klinische Wochenschrift · doi:10.1007/s00508-009-1181-z · Cited by 45 · see citing works
Altered positional regulation of nasal patency in patients with obstructive sleep apnoea syndrome
Hellgren, J., Yee, B. J., Dungan, G. C., & Grunstein, R. R. (2008) · European Archives of Oto-Rhino-Laryngology · doi:10.1007/s00405-008-0701-1 · Cited by 16 · see citing works
Iwata, N., Nakata, S., Inada, H., Kimura, A., Hirata, M., & Yasuma, F. (2020) · Auris Nasus Larynx · doi:10.1016/j.anl.2020.06.005 · Cited by 15 · see citing works
Tolerance of Continuous Positive Airway Pressure After Sinonasal Surgery
Reilly, E., Boon, M., Vimawala, S., Chitguppi, C., Patel, J., Murphy, K., Doghramji, K., Nyquist, G., Rosen, M., Rabinowitz, M. R., et al. (2020) · The Laryngoscope · doi:10.1002/lary.28968 · Cited by 14 · see citing works
Znaczenie czynnościowej chirurgii nosa w leczeniu obturacyjnego bezdechu podczas snu (OBPS)
Balcerzak, J., Niemczyk, K., Arcimowicz, M., & Gotlib, T. (2007) · Otolaryngologia Polska · doi:10.1016/s0030-6657(07)70388-8 · Cited by 7 · see citing works
The Reliability and Influence of Body Position on Acoustic Pharyngometry and Rhinometry Outcomes
Knappe, S. W., & Sonnesen, L. (2020) · Journal of Oral and Maxillofacial Research · doi:10.5037/jomr.2020.11401 · Cited by 5 · see citing works
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The Role of Isolated Nasal Surgery in Obstructive Sleep Apnea Therapy—A Systematic Review
Schoustra, E., van Maanen, P., den Haan, C., Ravesloot, M. J. L., & de Vries, N. (2022) · Brain Sciences · doi:10.3390/brainsci12111446 · Cited by 39 · see citing works
“Three studies specifically evaluated the effect of nasal surgery in patients with CPAP intolerance [22,28,30].”
BackgroundTreatment of the Nose for Patients with Sleep Apnea
Callander, J. K., & Chang, J. L. (2023) · Otolaryngologic Clinics of North America · doi:10.1016/j.otc.2023.11.002 · Cited by 5 · see citing works
Vito, A. D., Donniacuo, A., Cammaroto, G., Meccariello, G., Baroni, C., Andrade, A., Mandalà, M., Lechien, J. R., & Olszewska, E. (2025) · European Archives of Oto-Rhino-Laryngology · doi:10.1007/s00405-025-09803-0 · Cited by 2 · see citing works
Sex Differences in Obstructive Sleep Apnea Including Pregnancy and Response to Treatment
Erickson, T. S., & Durr, M. L. (2024) · Otolaryngologic Clinics of North America · doi:10.1016/j.otc.2024.02.001 · Cited by 2 · see citing works
Park, S. I., Choi, W., Lee, C., Kim, H. Y., & Jung, Y. G. (2025) · Nature and Science of Sleep · doi:10.2147/nss.s487341 · Cited by 3 · see citing works
Knížek, Z., Kotulek, M., Brothánková, P., Pecháčková, E., Klail, P., Kostlivý, T., & Vodička, J. (2023) · Life · doi:10.3390/life13010219 · Cited by 2 · see citing works
The role of nasal patency in obstructive sleep apnea: an expert consensus
Vahabzadeh-Hagh, A. M., Strollo, P., Takashima, M., Yaremchuk, K., Heineman, T. E., Jacobowitz, O., Cai, Y., Chang, J. L., Suurna, M., Yan, C. H., et al. (2026) · Frontiers in sleep · doi:10.3389/frsle.2026.1819496 · Cited by 1 · see citing works
Cardon, B., & Burton, S. (2024) · Evidence-Based Practice · doi:10.1097/ebp.0000000000002084
The Impact of Sinonasal Pathology on Obstructive Sleep Apnea
Fong, S. X., & Aysola, R. (2024) · Current Treatment Options in Allergy · doi:10.1007/s40521-024-00373-w
Ang, L. F., Chua, N. Y. M., Loh, B. J. S., Pierro, F. D., & Ng, C. L. (2026) · Facial Plastic Surgery · doi:10.1055/a-2891-4516
The Impact of Breathing Pattern (Nasal vs. Oral) on the Severity of Obstructive Sleep Apnea
Čerkez, M. G., Birtić, D., Šestak, A., Jurić, J. Š., Jurić, S., Vinković, M. P., Čubra, M., & Kovačević, J. (2026) · Journal of Respiration · doi:10.3390/jor6030016
Osman, A. M., Carney, A. S., Joshi, H., Nguyen, P., CATCHESIDE, P. G., Ooi, E. H., & Eckert, D. J. (2026) · Journal of Sleep Research · doi:10.1111/jsr.70416
Kim, J., Cho, S.-W., & Kim, H. J. (2026) · Medicina · doi:10.3390/medicina62091798
Ohmura, K., Shirahata, T., Miyashita, T., Uchida, Y., Akagami, T., Sato, H., Masaki, K., Sekine, T., Watanabe, H., Nomura, Y., et al. (2026) · Respiratory Investigation · doi:10.1016/j.resinv.2026.101520
- Authors
- Elwany, S., Bahgat, A. Y., Ibrahim, M., & Bazak, R.
- Affiliations
- Alexandria University (EG)
- Corresponding author
- Bazak, Remon
- Venue
- Irish Journal of Medical Science (1971 -)
- Published
- 2022-01-27
- Volume
- 191
- Issue
- 6
- Pages
- 2723-2728
- ISSN
- 0021-1265 (ISSN-L)
- 1863-4362
- OpenAlex
- W4210316765
- Cited by
- 14
- References
- 35
- Citations by year
- 2026: 6 · 2025: 2 · 2024: 3 · 2023: 2 · 2022: 1
- FWCI
- 1.24
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Irish Journal of Medical Science (1971 -) (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Surgery › Nasal Surgery and Airway Studies
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- obstructive sleep apnea, nasal obstruction, nasal surgery, CPAP adherence, acoustic rhinometry, sleepiness
- MeSH terms
- Humans, Patient Compliance, Nasal Obstruction, Sleep Apnea, Obstructive, Rhinometry, Acoustic, Continuous Positive Airway Pressure
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