Page 57 - Portuguese Journal - SPORL - Vol 61. Nº1
P. 57
procedure and control polysomnography Table 1
after the surgery were selected. Patients Pre-surgery data
with incomplete data, those who underwent Variable N (total = 15)
multiple surgical interventions (multilevel Male/Female 13/2
surgery), and those who did not undergo
control polysomnography were excluded. Age 47 years (min. 35 – max. 69) (SD 8.19)
A total of 15 patients were evaluated. The Weight 85.92 kg (SD 2.47) (CI 80.47–91.37)
following variables were analyzed (before AHI 17.58/h (SD 2.6) (CI 11.86–23.65)
and after the surgical intervention): AHI, ODI, ODI 19.73/h (SD 2.02) (CI 15.27–24.19)
SpO min, ESS scores, and body weight. This SpO min 80.33% (SD 1.85) (CI 76.24–84.41)
2
assessment was performed during a period of 2
three to six months after the surgery. ESS 8.75 (SD 1.10) (CI 6.31–19.50)
Descriptive statistical analysis of the sample Abbreviations: AHI, apnea-hypopnea index; ODI, oxygen
desaturation index; SpO2min, minimum peripheral oxygen
was performed using the IBM SPSS Statistics saturation; ESS, Epworth Sleepiness Scale; SD, standard deviation;
25 software . The significance level was set at CI, confidence interval.
5% (p<0.05). score, which decreased from 8.75 (SD 1.1) to 6.5
(SD 1.01) (p=0.015). There were no statistically
Results significant differences between the SpO min
2
Thirteen of the 15 patients (86.6%) included before (80.33%, SD 1.85) and after the surgery
in the study were men, and only two (13.4%) (85.22%, SD 1.56) (p=0.089), nor between the
were woman. The mean age was 47 years weight before (85.92 kg) and after (85.86 kg)
(minimum 35 years, maximum 69 years, the surgery (p=0.862).
standard deviation [SD] 8.19). At the time of Table 3 lists the results of the tests of association
diagnosis, the mean weight of the patients for the analyzed variables before and after the
was 85.92 kg (95% confidence interval [CI] surgery.
80.47–91.37, SD 2.47), mean AHI was 17.58/h
(95% CI 11.86–23.65, SD 2.6), mean ODI was Discussion
19.73/h (95% CI 15.27–24.19, SD 2.02), SpO min In this study, there was a statistically
2
was 80.33 % (95% CI 76.24–84.41, SD 1.85), and significant improvement in the AHI, ODI,
the mean ESS score was 8.75 (95% CI 6.31–19.50, and daytime sleepiness after nasal surgery.
SD 1.10). Table 1 shows the data of the patients The reported physiological mechanisms
before the surgical intervention. through which nasal obstruction conditions
Regarding the surgical procedures, all or contributes to OSA include the Starling
patients underwent septoplasty and inferior resistor model, shunting of airflow through a
turbinoplasty. In some patients, there was a collapsible oral airway, blockage of the nasal
need to add other nasal surgical procedures. respiratory reflex, and reduced nitric oxide
One patient also had nasal valve surgery, three production . Moreover, complete resistance
19
patients had additional endoscopic endonasal of the airway correlates with the respiratory
surgery (for polypectomy, middle meatotomy, effort, with the nasal cavities accounting for
and/or anterior ethmoidectomy), and one more than half of this resistance . Reduced
20
patient required additional rhinoplasty. nasal flow is associated with decreased
Compared to the values before the surgery, sleep quality, increased daytime sleepiness,
tests of association showed a statistically and increased risk of snoring and OSA .
21
significant improvement after the surgery Paradoxically, nasal surgery has been shown
in the following: mean AHI, which decreased to be effective in improving the adaptation to
from 17.58/h (SD 2.6) to 9.18/h (SD 2.4) (p=0.019); CPAP, quality of life, and daytime sleepiness,
mean ODI, which decreased from 19.73/h (SD but its effect on the reduction in the AHI
2.02) to 8.3/h (SD 2.38) (p=0.008); mean ESS is usually negligible 21,22 . In this study, there
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