Page 56 - Portuguese Journal - SPORL - Vol 61. Nº1
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memory, and mood. If it is not properly positional therapy, mandibular advancement
addressed and treated, it is associated with an devices, and surgery, in addition to measures
increased risk of adverse events such as driving such as weight loss and abstaining from
accidents, neuropsychiatric dysfunction, brain alcohol and medications that can cause
and cardiovascular morbidity, pulmonary muscle hypotonia 9,10 . Surgery, which is usually
hypertension, type 2 diabetes, and metabolic multilevel, has curative potential and high
syndrome . effectiveness (because it does not depend
2,3
Mild OSA is defined by an apnea-hypopnea on patient adherence) and thus plays an
index (AHI) between 5 and 15 events/h, and important role, being advocated by some
treatment is only recommended in the authors as the first-line treatment in selected
presence of obstructive sleep apnea syndrome cases 11,12 . Moreover, the American Academy of
(OSAS). OSAS is characterized by an AHI>5 Sleep Medicine (AASM) strongly recommends
associated with symptoms such as excessive that patients with OSA and BMI<40 Kg/m
2
daytime sleepiness with Epworth Sleepiness who are intolerant or non-adherent to CPAP
Scale (ESS)>11 or the presence of two or be referred to a sleep surgeon .
10
more of the following symptoms: repetitive Several factors must be considered while
episodes of nocturnal breathing cessation, selecting the surgical technique—the
feeling of non-restorative sleep, frequent presence of a fixed or dynamic anatomic
awakenings during sleep, daytime tiredness obstruction and preservation of physiological
and fatigue, and difficulty in concentrating. function .
13
The treatment of OSA is advised for moderate Nasal surgery has been shown to contribute
apnea (15<AHI<30) and severe apnea (AHI>30), to reduced upper airway resistance with
even in the absence of symptoms due to the beneficial effects, such as improved quality of
associated increased cardiovascular risk . life and sleep, adaptation to CPAP, and better
3
The first-line treatment of moderate or severe outcomes of multilevel surgery. Nevertheless,
OSA is continuous positive pressure ventilation, it is argued that it does not decrease the AHI
which can be administered in various ways, and is not recommended as the sole procedure
including continuous, automatic, and bilevel to treat moderate to severe OSA 14-16 . However,
positive airway pressure. This method was some authors have claimed that nasal surgery
described for the first time in 1981 and alone can improve the AHI in adequately
highly effective in improving or eliminating selected patients and should be considered
hypoxemia and consequent microarousals . a treatment option in this condition 17,18 . This
4,5
However, the rate of patient adherence is often study aimed to determine the effectiveness
suboptimal, varying between 40% and 85%, of nasal surgery when used alone for the
due to sociodemographic and psychosocial treatment of OSAS.
factors and the adverse effects of the therapy—
nasal congestion and airway dryness—which Material and Methods
reduce its effectiveness . Approximately 8% of The clinical records of patients aged 18 years
6,7
patients stop using CPAP in the first night, and or older who attended the Snoring and Sleep
around 50% abandon the therapy during the Apnea Clinic of the Hospital CUF Tejo between
first year of use. Even with the implementation January 1, 2018, and August 30, 2021, were
of behavioral measures, this trend has been reviewed and screened. The purpose was to
stable in recent years . Thus, other more identify patients with a diagnosis of OSAS
8
individualized treatment options should be who were evaluated by polysomnography,
considered for patients who refuse or cannot drug-induced sleep endoscopy (DISE), and
tolerate ventilation therapy after considering computed tomography (CT) of the paranasal
the nature of the obstruction and the patient’s sinuses and pharynx. The patients who
preference . Examples of treatment include underwent nasal surgery as the sole treatment
9
56 Portuguese Journal of Otorhinolaryngology - Head and Neck Surgery
