. Author manuscript; available in PMC: 2024 Jan 1.

Published in final edited form as: Int Forum Allergy Rhinol. 2023 Mar 30;13(7):1061–1482. doi: 10.1002/alr.23079

TABLE IX.D.2.

Evidence for nasal surgery to treat OSA

Study	Year	LOE	Study design	Study groups	Clinical end-point	Conclusion
Wu et al.¹⁶⁶⁰	2017	2a	Meta-analysis	17 studies (2002–2016): 1 RCT, 2 nonrandomized control, 11 prospective, 3 retrospective	Association of isolated nasal surgery with improvement in apnea hypopnea index (AHI), ESS.	Both AHI and ESS improved significantly after nasal surgery. AHI change 4.15 events/h (−6.5 to −1.8).
Ishii et al.⁵⁴⁵	2015	2a	Meta-analysis	10 studies: two RCTs, seven prospective, one retrospective	AHI, RDI, ESS.	No significant improvement in AHI; significant improvement in RDI and ESS. RDI declined by 11 events/h (−16 to −6).
Li et al.⁹⁰⁶	2011	2a	Meta-analysis	13 studies (1999–2009): one RCT, one nonrandomized control, nine prospective, two cross-sectional	Changes in nasal resistance, AHI, ESS, snoring.	Changes in AHI after nasal surgery were not statistically significant; variable results in reduction of snoring; statistically significant reduction in ESS.
Koutsourelakis et al.¹⁶⁶¹	2008	1b	RCT	49 OSA patients with fixed nasal obstruction due to deviated septum	Association of septoplasty with increased nasal breathing epochs and reduction in AHI.	No significant decrease in AHI; change in AHI after surgery inversely related to change in nasal breathing epochs.
Shuaib et al.⁹¹¹	2015	4	Case series	26 patients with septal and nasal valve obstruction	Association between functional septorhinoplasty and AHI.	Significant decrease of 35% in mean postoperative AHI.
Yalamanchali et al.⁹²¹	2014	4	Case series	56 patients with mild, moderate, or severe OSA	Association between combined nasal surgery and endoscopic sinus surgery on measurements of OSA and sleep architecture.	Small, statistically significant reduction in AHI in patients with moderate to severe OSA.
Moxness et al.¹⁶⁶³	2014	2b	Prospective cohort	59 patients with OSA and clinically significant nasal obstruction	Association of either 1) septoplasty alone, or 2) septoplasty with turbinate reduction with OSA parameters. Evaluated 3 months postop.	Significant reduction in AHI in the group that had septoplasty with turbinate reduction (17.4–11.7 postop) Sleepiness improved in both groups.
Park et al.¹⁶⁵⁹	2014	4	Case series	25 patients with reduced nasal cavity patency and narrowing of retroglossal or retropalatal airways with OSA	Association of septoplasty and turbinoplasty with improvement in OSA parameters (AHI, RDI, ESS).	Significant decrease in AHI and RDI; reduction in subjective symptoms. ESS improved even in those categorized as AHI non-responders.
Li et al.⁹⁰⁹	2009	2b	Cohort	66 patients with OSA and chronic nasal obstruction	Association of nasal surgery with ESS, PSG parameters, AHI, snoring (Snoring Outcome Survey).	Significantly improved SOS and ESS; insignificant changes in polysomnographic parameters.
Hu et al.¹⁶⁶⁴	2013	2b	Cohort	79 OSA/hypopnea syndrome patients with nasal obstruction	Association of nasal surgery with polysomnographic parameters (AHI), and nasal resistance.	Inconsistent decrease in AHI depending on severity of OSAHS; significant decrease in nasal resistance.