Obstructive sleep apnea (OSA) is a common disorder characterized by upper
airway obstruction during
sleep. To reduce the
morbidity of OSA,
sleep specialists have explored various
methods of managing the condition, including manifold positive
airway pressure (PAP)
techniques and
surgical procedures.
Nasal obstruction can cause significant discomfort during
sleep, and it is likely that improving
nasal obstruction would enhance the
quality of life and PAP
compliance of OSA
patients. Many reliable studies have offered evidence to support this assumption. However, few comprehensive guidelines for managing OSA through
nasal surgery encompass all this evidence. In order to
address this gap, the Korean Society of
Otorhinolaryngology-
Head and
Neck Surgery (KORL-HNS) and the Korean Society of
Sleep and
Breathing designated a
guideline development group (GDG) to develop recommendations for
nasal surgery in OSA
patients. Several databases, including OVID
Medline, Embase, the Cochrane
Library, and KoreaMed, were searched to identify all relevant
papers using a predefined search strategy. The types of
nasal surgery included septoplasty,
turbinate surgery, nasal valve
surgery, septorhinoplasty, and endoscopic sinus
surgery. When
insufficient evidence was found, the GDG sought
expert opinions and attempted to fill the
evidence gap. Evidence-based recommendations for practice were ranked according to the American College of
Physicians’ grading system. The GDG developed 10 key action
statements with supporting text to support them. Three
statements are ranked as strong recommendations, three are only recommendations, and four can be considered options. The GDG
hopes that this
clinical practice guideline will help
physicians make optimal decisions when
caring for OSA
patients. Conversely, the
statements in this
guideline are not intended to limit or restrict
physicians’ care based on their experience and assessment of individual
patients.