Critical appraisal and meta-analysis of nasal surgery for obstructive sleep apnea

Am J Rhinol Allergy. 2011 Jan-Feb;25(1):45-9. doi: 10.2500/ajra.2011.25.3558.


Background: Nasal surgery is commonly involved in surgical treatment for obstructive sleep apnea (OSA). The aim of this study was to investigate the outcomes of nasal surgery for OSA using evidence-based methodology.

Methods: The MedLine database (1999∼2009) was searched for original articles published in peer-reviewed journals concerning nasal surgery for snoring/sleep apnea. Data extracted from these articles were reviewed and analyzed using meta-analysis technology.

Results: Thirteen articles were critically appraised. Two studies provided control groups and 11 articles (84.6%) consisted of prospective noncontrolled clinical trials (level II in evidence strength). The weighted mean apnea/hypopnea index measured by polysomnography in nine studies decreased from 35.2 ± 22.6 to 33.5 ± 23.8 event/hour after nasal surgery (overall, p = 0.69). The pooled success rate of nasal surgery in treating OSA was 16.7%. Epworth Sleepiness Scale scores in eight studies decreased from 10.6 ± 3.9 to 7.1 ± 3.7 (overall, p <0.001). Nasal surgery for snoring assessed by individual questionnaires and visual analog scale reported significant improvement (p < 0.05).

Conclusion: The critical literature appraisal and meta-analyses show that nasal surgery can effectively reduce daytime sleepiness and snoring. However, the efficacy of nasal surgery in treating OSA is limited.

Publication types

  • Meta-Analysis

MeSH terms

  • Adult
  • Clinical Trials as Topic
  • Disease Progression
  • Evidence-Based Medicine
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nose / pathology
  • Nose / surgery*
  • Polysomnography
  • Reconstructive Surgical Procedures*
  • Sleep Apnea, Obstructive / diagnosis
  • Sleep Apnea, Obstructive / epidemiology
  • Sleep Apnea, Obstructive / physiopathology
  • Sleep Apnea, Obstructive / surgery*
  • Snoring / prevention & control
  • Treatment Outcome
  • United States