Outcome of Continuous Positive Airway Pressure Adherence Based on Nasal Endoscopy and the Measurement of Nasal Patency-A Prospective Study.

The gold standard for treating obstructive sleep apnea in adults is continuous positive airway pressure (CPAP). However, it can be difficult to convince patients to adhere to this therapy. The aim of this study was to determine the relationship between nasal endoscopy findings/nose patency and CPAP adherence. Material and methods: A cohort of 450 consecutive patients suspected of having OSA were prospectively enrolled. For further analyses, 47 OSA patients undergoing CPAP treatment were selected (13 females and 34 males, average age, 65.3 years, BMI 34.1, apnea-hypopnea index. AHI 51.0). The patients were divided into two groups: patients with good CPAP adherence (n = 35) and patients who did not adhere to CPAP therapy (n = 12). The influence of nasal endoscopy and flow measurement on CPAP adherence was explored. Results: We found a statistical independence between adherence to CPAP and AHI (p = 0.124), T90 (p = 0.502), endoscopic findings (p = 0.588) and nasal patency measured by a flowmeter (p = 0.498). Conclusions: In our studied sample, endoscopic findings and nasal patency measured by a flowmeter were not predictors of CPAP non-adherence in the first year of the treatment. Our data show that while an endoscopic finding in the nasal cavity could indicate that a patient has a severe obstruction, compliance with CPAP therapy is not reduced in these patients and neither is it reduced with a decrease in nasal flow, according to our observation.

[Olfactory function in patients undergoing FESS for chronic rhinosinusitis]. / Cich u pacientu podstupujících endonazální endoskopickou chirurgii.

Patients with chronic rhinosinusitis (CRS) often suffer from loss of olfactory function. Rhinosinusitis can be treated either by medical therapy or surgically (FESS). Postoperative outcome in terms of improving sense of smell has been controversial so far. The aim of our study was to determine the patients who would have better postoperative outcomes in terms of improving olfactory function. We collected data of patients undergoing FESS for chronic rhinosinusitis (either with or without nasal polyps) at our department during the years 2012-2015. These patients had their olfactory function examined with Odorized markers test (OMT) up to 24 hours before surgery. After that we chose the best result in OMT found out in visits from 4 weeks to 4 months after surgery. We were comparing individual risk factors out of the patients´ anamnesis, CT scan and physical examination. 51 patients were enrolled in this study. 25 % of patients showed improvement of their olfactory function, no change was recorded in 55 % of patients and 20 % of patients showed deterioration of olfaction. Before surgery we found out statistically significant difference in results of OMT between the patients with and without nasal polyps and with and without asthma (p = 0,0016, resp. p = 0,04). After surgery the difference was no longer statistically significant (p = 0,17, resp. p = 0,12). Correlation with age and Lund-Mackay score showed changes after surgery. No statistically significant difference in results of OMT was found out before and after surgery in other observed risk factors (oral corticosteroids before surgery, smoking, revision surgery and middle turbinate resection). Changes in olfactory function in patients with chronic rhinosinusitis after surgery are hard to predict. Our results show that nasal polyps, asthma, lower age and higher Lund-Mackay score are factors which predict better postoperative outcome.