Clinical Practice Guideline: Clinical Efficacy of Nasal Surgery in the Treatment of Obstructive Sleep Apnea

Abstract

Obstructive sleep apnea (OSA) is a common disorder characterized by upper airway obstruction during sleep. To reducethe morbidity of OSA, sleep specialists have explored various methods of managing the condition, including manifold pos-itive airway pressure (PAP) techniques and surgical procedures. Nasal obstruction can cause significant discomfort duringsleep, and it is likely that improving nasal obstruction would enhance the quality of life and PAP compliance of OSA pa-tients. Many reliable studies have offered evidence to support this assumption. However, few comprehensive guidelines formanaging OSA through nasal surgery encompass all this evidence. In order to address this gap, the Korean Society of Oto-rhinolaryngology-Head and Neck Surgery (KORL-HNS) and the Korean Society of Sleep and Breathing designated aguideline development group (GDG) to develop recommendations for nasal surgery in OSA patients. Several databases, in-cluding OVID Medline, Embase, the Cochrane Library, and KoreaMed, were searched to identify all relevant papers usinga predefined search strategy. The types of nasal surgery included septoplasty, turbinate surgery, nasal valve surgery, septo-rhinoplasty, and endoscopic sinus surgery. When insufficient evidence was found, the GDG sought expert opinions and at-tempted to fill the evidence gap. Evidence-based recommendations for practice were ranked according to the AmericanCollege 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 op-tions. The GDG hopes that this clinical practice guideline will help physicians make optimal decisions when caring for OSApatients. Conversely, the statements in this guideline are not intended to limit or restrict physicians’ care based on their ex-perience and assessment of individual patients.