The Impact of Sinonasal Pathology on Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a prevalent condition characterized by repetitive collapse of the upper airway leading to sleep fragmentation and hypoxemia. The resulting hypoxemia leads to cascades of inflammatory, vascular and metabolic dysregulation which underlies the cardiovascular repercussions of the condition. The purpose of this review is to examine recent studies shedding light on treatments which highlight the impact of sinonasal pathology on OSA.

The medical treatment for nasal congestion can indirectly improve OSA. Studies on multiple anti-inflammatory agents have demonstrated reduction in the apnea hypopnea index (AHI), improvement in oxygen saturation and increased positive airway pressure (PAP) compliance. There are surgical interventions for OSA which are targeted for a specific patient population – such procedures generally increase nasal air space to improve nasal airflow. These procedures have been shown to reduce AHI, increase oxygen saturation and improve nasal and daytime symptoms. Septoplasty and turbinectomy are effective for those with deviated septum, or turbinate hypertrophy. Rapid palatal expansion is specifically for pediatric patients with a narrow and/or high palate. Distraction osteogenesis maxillary expansion is for adults with a narrow and/or high palate.

Sinonasal pathology can have an impact on OSA severity and treatment. Medications and surgeries treating sinonasal pathology can potentially improve OSA symptoms, reduce OSA severity and promote longevity in PAP compliance.