Page 58 - Portuguese Journal - SPORL - Vol 61. Nº1

Table 2
Tests of association

Variable Before surgery After surgery p-value
AHI 17.58/h (SD 2.6) (CI 11.86–23.65) 9.18/h (SD 2.4) (CI 3.83–14.53) 0,019
ODI 19.73/h (SD 2.02) (CI 15.27–24.19) 8.3/h (SD 2.38) (CI 3.06–13.55) 0,008
SpO 80.33% (SD 1.85) (CI 76.24–84.41) 85.22% (SD 1.56) (CI 81.55–88.44) 0,089
2
ESS 8.75 (SD 1.10) (CI 6.31–19.50) 6.50 (SD 1.01) (CI 4.26–8.74) 0,015
Weight 85.92 kg (SD 2.47) (CI 80.47–91.37) 85.86 kg (SD 2.42) (CI 80.53–91.20) 0,862

was a significant improvement in daytime severity of OSA is well established . In our study,
24
sleepiness, as assessed by the ESS, which was the association between the initial weight and
associated with a significant reduction in the weight after the surgical intervention was not
AHI. statistically significant (p=0.862), which makes
Wu et al. obtained similar results in a meta- weight variation an improbable causal factor

analysis in which the authors analyzed 18 of the observed associations.
articles with a total of 587 patients who Thus, in this study, nasal surgery alone was
underwent nasal surgery as the sole treatment effective in treating OSA in some patients as it
and observed a significant improvement in allowed a reduction in the AHI to values below
the AHI and ESS scores . The patients’ mean five events/h. Moreover, it was effective in the
17
age in that study was 44 years, and 90.5% of treatment of OSAS in all patients, as they all
the patients were male, characteristics similar achieved an AHI below 15 events/h without
to those of the population evaluated in this symptoms (as assessed by the ESS scores)
study. and therefore did not require complementary
Currently, the AHI is considered the primary treatments.
parameter for the evaluation of OSA, while Despite the promising results, most studies on
ODI and SpO min are considered secondary this topic report that the role of nasal surgery
2
measures. We observed a statistically in the treatment of OSAS or OSA is limited
significant reduction between the ODI scores to an improvement in snoring, adherence to
before and after the surgery. There is no CPAP, or the outcomes of multilevel surgery.
reference in the literature regarding the use Similar to our study (although prospective),
of this parameter to evaluate the effectiveness Friedman et al. conducted a study with 50
of nasal intervention in patients with OSA. patients to evaluate the improvement in sleep
Nevertheless, we deem this reduction after nasal surgery alone . They showed an
25
important because it reflects a reduction in expected subjective improvement in the nasal
intermittent hypoxia, whose harmful effects symptoms and daytime hypersomnolence
(release of reactive oxygen species and without a consistent statistically significant
inflammatory mediators) contribute to the improvement in the respiratory disturbance
comorbidities seen in these patients . index. The improvement in SpO min depended
23
2
However, there was no association between on the severity of OSA. However, there was a
minimum SpO before and after the surgery. statistically significant reduction in the levels
2
Notably, these values were low ab initio, with of CPAP pressure required to correct OSA,
a mean value of 80.33% (CI 76.24-84.41), which which demonstrates the fundamental role
indicates an undiagnosed disease of the lower of nasal surgery in the treatment of OSA. In
respiratory tract and/or the presence of other a meta-analysis conducted by Ishii et al., in
important variables that were not analyzed, which 10 studies with a total of 320 patients
namely smoking. The relationship between were analyzed, the authors demonstrated a
body weight reduction and a decrease in the significant improvement in the ESS scores

58 Portuguese Journal of Otorhinolaryngology - Head and Neck Surgery