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CC BY-NC-ND 4.0 · Sleep Sci 2024; 17(03): e310-e321
DOI: 10.1055/s-0044-1782527
DOI: 10.1055/s-0044-1782527
Review Article
Role of Nasal Surgery in Adult Obstructive Sleep Apnea: A Systematic Review
Funding The authors declare that the present study was supported by the final dissertation of the Continuing Education Master's Program in Advanced Rhinology and Anterior Skull Base, Universidad Internacional de Andalucía.
Abstract
Objective To perform a systematic review to determine if isolated nasal surgery has any impact on subjective or objective parameters in adult obstructive sleep apnea (OSA) patients.
Materials and Methods From December 2022 to March 2023, we conducted a search on the PubMed, Cochrane, Scopus, and Web of Science databases. Two independent investigators performed a study selection according to the established criteria, as well as data collection, including the study design, the subjective and objective parameters addressed, the type of intervention, and the outcomes, considering the methodological quality and risk of bias.
Results In total, 25 studies met the selection criteria, and they showed that there is a significant improvement in sleep quality, sleepiness, nasal resistance, and snoring after isolated nasal surgery. Still, there is no relevant modification of other polysomnographic parameters. It also reduces the required titration pressures of continuous positive airway pressure (CPAP) and increases the duration of its use.
Conclusion Isolated nasal surgery is not a primary treatment for OSA. Still, it improves the subjective parameters and can lead to CPAP therapy success by enhancing its effectiveness and long-term compliance.
Keywords
sleep apnea - obstructive - nasal obstruction - sleep apnea syndromes - nasal surgical procedures - systematic reviewPublication History
Received: 15 April 2023
Accepted: 27 September 2023
Article published online:
10 May 2024
© 2024. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Benjafield AV, Ayas NT, Eastwood PR. et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med 2019; 7 (08) 687-698
- 2 Salman LA, Shulman R, Cohen JB. Obstructive Sleep Apnea, Hypertension, and Cardiovascular Risk: Epidemiology, Pathophysiology, and Management. Curr Cardiol Rep 2020; 22 (02) 6
- 3 Javaheri S, Barbe F, Campos-Rodriguez F. et al. Sleep Apnea: Types, Mechanisms, and Clinical Cardiovascular Consequences. J Am Coll Cardiol 2017; 69 (07) 841-858
- 4 Reutrakul S, Mokhlesi B. Obstructive Sleep Apnea and Diabetes: A State of the Art Review. Chest 2017; 152 (05) 1070-1086 [Internet]
- 5 Li M, Li X, Lu Y. Obstructive sleep apnea syndrome and metabolic diseases. Endocrinology 2018; 159 (07) 2670-2675
- 6 Bassetti CLA, Randerath W, Vignatelli L. et al. EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke. Eur Respir J 2020; 55 (04) 1901104 [Internet]
- 7 Mediano O, González Mangado N, Montserrat JM. et al; el Spanish Sleep Network. Documento internacional de consenso sobre apnea obstructiva del sueño. Arch Bronconeumol 2022; 58 (01) 52-68
- 8 Randerath W, Verbraecken J, de Raaff CAL. et al. European Respiratory Society guideline on non-CPAP therapies for obstructive sleep apnoea. Eur Respir Rev 2021; 30 (162) 210200
- 9 de Carlos F, Anitua E, Gonzalez M, Macias E, Cobo J, Monasterio C. et al. Guia española de practica clinica. utilización de los dispositivos de avance mandibular en el tratamiento de pacientes adultos con síndrome de apnea hipopnea del sueño. 2017
- 10 Schwartz M, Acosta L, Hung YL, Padilla M, Enciso R. Effects of CPAP and mandibular advancement device treatment in obstructive sleep apnea patients: a systematic review and meta-analysis. Sleep Breath 2018; 22 (03) 555-568
- 11 Omobomi O, Quan SF. Positional therapy in the management of positional obstructive sleep apnea-a review of the current literature. Sleep Breath 2018; 22 (02) 297-304
- 12 O'Connor-Reina C, Plaza G, Garcia-Iriarte MT. et al. Tongue peak pressure: a tool to aid in the identification of obstruction sites in patients with obstructive sleep apnea/hypopnea syndrome. Sleep Breath 2020; 24 (01) https://www.proquest.com/scholarly-journals/tongue-peak-pressure-tool-aid-identification/docview/2385998486/se-2?accountid=14550 [Internet] 281-286
- 13 O'Connor-Reina C, Ignacio Garcia JM, Rodriguez Ruiz E. et al. Myofunctional therapy app for severe apnea–hypopnea sleep obstructive syndrome: Pilot randomized controlled trial. JMIR Mhealth Uhealth 2020; 8 (11) e23123
- 14 O'Connor-Reina C, Ignacio Garcia JM, Rodriguez Alcala L. et al. Improving adherence to myofunctional therapy in the treatment of sleep-disordered breathing. J Clin Med 2021; 10 (24) 5772
- 15 Mediano O, Romero-Peralta S, Resano P. et al. Obstructive sleep apnea: Emerging treatments targeting the genioglossus muscle. J Clin Med 2019; 8 (10) 1-18
- 16 Kim KB, Movahed R, Malhotra R, Stanley J. Management of Obstructive Sleep Apnea An Evidence-Based, Multidisciplinary Textbook. 1st ed. Ki Beom Kim, Reza Movahed, Raman K. Malhotra JJS, editor. Switzerland:: Springer Cham;; 2021: 646 p.
- 17 Bikov A, Dragonieri S. Obstructive Sleep Apnea Epidemiology, Pathomechanism and Treatment. Switzerland:: MDPI AG PP - Basel;; 2020: 96 p
- 18 Rabie AN, Mady O, El-Shazly AN, Abouzeid A. Systematic Review and Meta-Analysis of the Palatal Surgeries in the Treatment of Obstructive Sleep Apnea. Int J Otolaryngol Head &. Neck Surg. 2021; 10 (02) 61-74
- 19 Guzman MA, Sgambati FP, Pho H. et al. The Efficacy of Low-Level Continuous Positive Airway Pressure for the Treatment of Snoring. J Clin Sleep Med 2017; 13 (05) 703-711
- 20 Patil SP, Ayappa IA, Caples SM, Kimoff RJ, Patel SR, Harrod CG. Treatment of Adult Obstructive Sleep Apnea With Positive Airway Pressure: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment. J Clin Sleep Med 2019; 15 (02) 301-334
- 21 Plaza G. . O'Connor-Reina, Carlos, Baptista Jardin P. Diagnóstico y Tratamiento de los Trastornos Respiratorios del Sueño. Actualización en Diagnóstico y Tratamiento Quirúrgico [Internet]. 2nd ed. Axon, editor. Madrid; 2022 . 611 p. Available from: https://axon.es/ficha/libros/9788409443635/diagnostico-y-tratamiento-de-los-trastornos-respiratorios-del-sueno-actualizacion-en-diagnostico-y-tratamiento-quirurgico
- 22 Yetkin O, Kunter E, Gunen H. CPAP compliance in patients with obstructive sleep apnea syndrome. Sleep Breath 2008; 12 (04) 365-367
- 23 Hussain SF, Irfan M, Waheed Z, Alam N, Mansoor S, Islam M. Compliance with continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea among privately paying patients- a cross sectional study. BMC Pulm Med 2014; 14: 188
- 24 Weaver TE. Don't start celebrating–CPAP adherence remains a problem. J Clin sleep Med JCSM Off Publ Am Acad. Sleep Med 2013; 9 (06) 551-552
- 25 Chen C, Wang J, Pang L, Wang Y, Ma G, Liao W. Telemonitor care helps CPAP compliance in patients with obstructive sleep apnea: a systemic review and meta-analysis of randomized controlled trials. Ther Adv Chronic Dis 2020; 11: 20 40622320901625
- 26 Mehrtash M, Bakker JP, Ayas N. Predictors of Continuous Positive Airway Pressure Adherence in Patients with Obstructive Sleep Apnea. Lung 2019; 197 (02) 115-121
- 27 Ferris Jr BGJ, Mead J, Opie LH. Partitioning of Respiratory Flow Resistance in Man. J Appl Physiol 1964; 19: 653-658
- 28 Fokkens WJ, Lund VJ, Mullol J. et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2012. Rhinol Suppl 2012; 23: 3 , 1–298
- 29 Fokkens WJ, Lund VJ, Hopkins C. et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology 2020; 58 (Suppl S29): 1-464
- 30 Fried J, Yuen E, Li A. et al. Rhinologic disease and its impact on sleep: a systematic review. Int Forum Allergy Rhinol 2021; 11 (07) 1074-1086
- 31 Fidan T, Fidan V, Ak M, Sütbeyaz Y. Neuropsychiatric symptoms, quality of sleep and quality of life in patients diagnosed with nasal septal deviation. Kulak Burun Bogaz Ihtis Derg 2011; 21 (06) 312-317
- 32 Bengtsson C, Jonsson L, Holmström M, Svensson M, Theorell-Haglöw J, Lindberg E. Impact of nasal obstruction on sleep quality: a community-based study of women. Eur Arch Otorhinolaryngol 2015; 272 (01) 97-103
- 33 Campbell AP, Phillips KM, Hoehle LP. et al. Depression symptoms and lost productivity in chronic rhinosinusitis. Ann Allergy Asthma Immunol 2017; 118 (03) https://www.scopus.com/inward/record.uri?eid=2-s2.0-85014744242&doi=10.1016%2Fj.anai.2016.12.012&partnerID=40&md5=c25c5488c3a23f7db79bf6bfdc181dc3 [Internet] 286-289
- 34 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372 (71) 1-9
- 35 Clark J, Glasziou P, Del Mar C, Bannach-Brown A, Stehlik P, Scott AM. A full systematic review was completed in 2 weeks using automation tools: a case study. J Clin Epidemiol 2020; 121: 81-90
- 36 Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev 2016; 5 (01) 210
- 37 Sterne JAC, Hernán MA, Reeves BC. et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016; 355: i4919 https://www.bmj.com/content/355/bmj.i4919 [Internet]
- 38 Pham LV, Schwartz AR. The pathogenesis of obstructive sleep apnea. J Thorac Dis 2015; 7 (08) 1358-1372
- 39 Smith PL, Wise RA, Gold AR, Schwartz AR, Permutt S. Upper airway pressure-flow relationships in obstructive sleep apnea. J Appl Physiol 1988; 64 (02) 789-795
- 40 Sistla SK, Paramasivan VK, Agrawal V. Anatomic and Pathophysiologic Considerations in Surgical Treatment of Obstructive Sleep Apnea. Sleep Med Clin 2019; 14 (01) 21-31
- 41 Katz ES, D'Ambrosio CM. Pathophysiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc 2008; 5 (02) 253-262
- 42 Katyal V, Pamula Y, Martin AJ, Daynes CN, Kennedy JD, Sampson WJ. Craniofacial and upper airway morphology in pediatric sleep-disordered breathing: Systematic review and meta-analysis. Am J Orthod Dentofacial Orthop 2013; 143 (01) 20-30.e3
- 43 Fitzpatrick MF, McLean H, Urton AM, Tan A, O'Donnell D, Driver HS. Effect of nasal or oral breathing route on upper airway resistance during sleep. Eur Respir J 2003; 22 (05) https://www.scopus.com/inward/record.uri?eid=2-s2.0-0242720153&doi=10.1183%2F09031936.03.00047903&partnerID=40&md5=66cdd4edb0e278e5b46442db0db8a939 [Internet] 827-832
- 44 Yoo F, Schlosser RJ, Storck KA, Ganjaei KG, Rowan NR, Soler ZM. Effects of endoscopic sinus surgery on objective and subjective measures of cognitive dysfunction in chronic rhinosinusitis. Int Forum Allergy Rhinol 2019; 9 (10) 1135-1143
- 45 Alt JA, Ramakrishnan VR, Platt MP, Schlosser RJ, Storck T, Soler ZM. Impact of chronic rhinosinusitis on sleep: a controlled clinical study. Int Forum Allergy Rhinol 2019; 9 (01) 16-22
- 46 Bengtsson C, Lindberg E, Jonsson L. et al. Chronic rhinosinusitis impairs sleep quality: Results of the GA2LEN study. Sleep 2017;40(01): https://www.scopus.com/inward/record.uri?eid=2-s2.0-85014152157&doi=10.1093%2Fsleep%2Fzsw021&partnerID=40&md5=affa7eb79c5c9b5dbd704e5a4cbef77e [Internet]
- 47 Jiang R-S, Liang K-L. The Influence of Functional Endoscopic Sinus Surgery on Sleep Related Outcomes in Patients with Chronic Rhinosinusitis. Int J Otolaryngol 2019; 2019: 7951045
- 48 Hoffstein V, Viner S, Mateika S, Conway J. Treatment of obstructive sleep apnea with nasal continuous positive airway pressure. Patient compliance, perception of benefits, and side effects. Am Rev Respir Dis 1992; 145 (4 Pt 1): 841-845
- 49 Suratt PM, Turner BL, Wilhoit SC. Effect of intranasal obstruction on breathing during sleep. Chest 1986; 90 (03) 324-329
- 50 Young T, Finn L, Kim H. The University of Wisconsin Sleep and Respiratory Research Group. Nasal obstruction as a risk factor for sleep-disordered breathing. J Allergy Clin Immunol 1997; 99 (02) S757-S762
- 51 Inoue A, Chiba S, Matsuura K, Osafune H, Capasso R, Wada K. Nasal function and CPAP compliance. Auris Nasus Larynx 2019; 46 (04) 548-558
- 52 Sugiura T, Noda A, Nakata S. et al. Influence of nasal resistance on initial acceptance of continuous positive airway pressure in treatment for obstructive sleep apnea syndrome. Respiration 2007; 74 (01) 56-60 https://www.scopus.com/inward/record.uri?eid=2-s2.0-33845733648&doi=10.1159%2F000089836&partnerID=40&md5=850460d4a5d821ee062ceaac6445d094 [Internet]
- 53 Fairbanks DN. Effect of nasal surgery on snoring. South Med J 1985; 78 (03) 268-270
- 54 Verse T, Maurer JT, Pirsig W. Effect of nasal surgery on sleep-related breathing disorders. Laryngoscope 2002; 112 (01) 64-68 https://www.scopus.com/inward/record.uri?eid=2-s2.0-0036137748&doi=10.1097%2F00005537-200201000-00012&partnerID=40&md5=74c96896f5a1783639a62fc659589d4c [Internet]
- 55 Li H-Y, Lin Y, Chen N-H, Lee L-A, Fang T-J, Wang P-C. Improvement in quality of life after nasal surgery alone for patients with obstructive sleep apnea and nasal obstruction. Arch Otolaryngol Head Neck Surg 2008; 134 (04) 429-433 https://www.scopus.com/inward/record.uri?eid=2-s2.0-42549118218&doi=10.1001%2Farchotol.134.4.429&partnerID=40&md5=d68b63fb6bd66fbc0837de0bdd6e48b2 [Internet]
- 56 Johns MW. Daytime sleepiness, snoring, and obstructive sleep apnea. The Epworth Sleepiness Scale. Chest 1993; 103 (01) 30-36
- 57 Koutsourelakis I, Georgoulopoulos G, Perraki E, Vagiakis E, Roussos C, Zakynthinos SG. Randomised trial of nasal surgery for fixed nasal obstruction in obstructive sleep apnoea. Eur Respir J 2008; 31 (01) 110-117 https://www.scopus.com/inward/record.uri?eid=2-s2.0-45849122533&doi=10.1183%2F09031936.00087607&partnerID=40&md5=7f05daa0125a038f4e2d820618317bd3 [Internet]
- 58 Kim ST, Choi JH, Jeon HG, Cha HE, Kim DY, Chung Y-S. Polysomnographic effects of nasal surgery for snoring and obstructive sleep apnea. Acta Otolaryngol 2004; 124 (03) 297-300
- 59 Nakata S, Noda A, Yasuma F. et al. Effects of nasal surgery on sleep quality in obstructive sleep apnea syndrome with nasal obstruction. Am J Rhinol 2008; 22 (01) 59-63 https://www.scopus.com/inward/record.uri?eid=2-s2.0-39749083919&doi=10.2500%2Fajr.2008.22.3120&partnerID=40&md5=efce73a4cad91488fc7046947b5d5449 [Internet]
- 60 Tosun F, Kemikli K, Yetkin S, Ozgen F, Durmaz A, Gerek M. Impact of endoscopic sinus surgery on sleep quality in patients with chronic nasal obstruction due to nasal polyposis. J Craniofac Surg 2009; 20 (02) 446-449
- 61 Park CY, Hong JH, Lee JH. et al. Clinical effect of surgical correction for nasal pathology on the treatment of obstructive sleep apnea syndrome. PLoS One 2014; 9 (06) e98765
- 62 Li H-Y, Lee L-A, Wang P-C, Fang T-J, Chen N-H. Can nasal surgery improve obstructive sleep apnea: subjective or objective?. Am J Rhinol Allergy 2009; 23 (06) e51-e55
- 63 Bican A, Kahraman A, Bora I, Kahveci R, Hakyemez B. What is the efficacy of nasal surgery in patients with obstructive sleep apnea syndrome?. J Craniofac Surg 2010; 21 (06) 1801-1806
- 64 Choi JH, Kim EJ, Kim YS. et al. Effectiveness of nasal surgery alone on sleep quality, architecture, position, and sleep-disordered breathing in obstructive sleep apnea syndrome with nasal obstruction. Am J Rhinol Allergy 2011; 25 (05) 338-341 https://www.scopus.com/inward/record.uri?eid=2-s2.0-80053262126&doi=10.2500%2Fajra.2011.25.3654&partnerID=40&md5=8d3eb12dbc6d426519d550f3fede7efd [Internet]
- 65 Virkkula P, Bachour A, Hytönen M. et al. Snoring is not relieved by nasal surgery despite improvement in nasal resistance. Chest 2006; 129 (01) 81-87 https://www.scopus.com/inward/record.uri?eid=2-s2.0-33144475991&doi=10.1378%2Fchest.129.1.81&partnerID=40&md5=d84d9b73ef123ae3cc95e2588e3d0e48 [Internet]
- 66 Kalam I. Objective assessment of nasal obstruction in snoring and obstructive sleep apnea patients: experience of a Police Authority Hospital. Ann Saudi Med 2002; 22 (3-4): 158-162
- 67 Schoustra E, van Maanen P, den Haan C, Ravesloot MJL, de Vries N. The Role of Isolated Nasal Surgery in Obstructive Sleep Apnea Therapy-A Systematic Review. Brain Sci 2022; 12 (11) 1446
- 68 Newsome H. Evidence-Based Medicine: The role of nasal surgery in treatment of obstructive sleep apnea. Facial Plast Surg 2023; 39 (03) 279-283
- 69 Sukato DC, Abramowitz JM, Boruk M, Goldstein NA, Rosenfeld RM. Endoscopic Sinus Surgery Improves Sleep Quality in Chronic Rhinosinusitis: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2018; 158 (02) 249-256
- 70 Wu J, Zhao G, Li Y. et al. Apnea-hypopnea index decreased significantly after nasal surgery for obstructive sleep apnea: A meta-analysis. Medicine (Baltimore) 2017; 96 (05) e6008
- 71 Wang M, Liu SY-C, Zhou B, Li Y, Cui S, Huang Q. Effect of nasal and sinus surgery in patients with and without obstructive sleep apnea. Acta Otolaryngol 2019; 139 (05) 467-472
- 72 Ishii L, Roxbury C, Godoy A, Ishman S, Ishii M. Does Nasal Surgery Improve OSA in Patients with Nasal Obstruction and OSA? A Meta-analysis. Otolaryngol Head Neck Surg 2015; 153 (03) 326-333
- 73 Sharma S, Wormald JCR, Fishman JM, Andrews P, Kotecha BT. Rhinological interventions for obstructive sleep apnoea - a systematic review and descriptive meta-analysis. J Laryngol Otol 2019; 133 (03) 168-176
- 74 Rotenberg BW, Murariu D, Pang KP. Trends in CPAP adherence over twenty years of data collection: a flattened curve. J Otolaryngol Head Neck Surg 2016; 45 (01) 43
- 75 Camacho M, Riaz M, Capasso R. et al. The effect of nasal surgery on continuous positive airway pressure device use and therapeutic treatment pressures: a systematic review and meta-analysis. Sleep 2015; 38 (02) 279-286
- 76 Mickelson SA. Nasal Surgery for Obstructive Sleep Apnea Syndrome. Otolaryngol Clin North Am 2016; 49 (06) 1373-1381
- 77 Cai Y, Goldberg AN, Chang JL. The Nose and Nasal Breathing in Sleep Apnea. Otolaryngol Clin North Am 2020; 53 (03) 385-395
- 78 Friedman M, Tanyeri H, Lim JW, Landsberg R, Vaidyanathan K, Caldarelli D. Effect of improved nasal breathing on obstructive sleep apnea. Otolaryngol Head Neck Surg 2000; 122 (01) 71-74
- 79 Sufioğlu M, Ozmen OA, Kasapoglu F. et al. The efficacy of nasal surgery in obstructive sleep apnea syndrome: a prospective clinical study. Eur Arch Otorhinolaryngol 2012; 269 (02) 487-494
- 80 Iwata N, Nakata S, Inada H, Kimura A, Hirata M, Yasuma F. Clinical indication of nasal surgery for the CPAP intolerance in obstructive sleep apnea with nasal obstruction. Auris Nasus Larynx 2020; 47 (06) 1018-1022
- 81 Brimioulle M, Chaidas K. Nasal function and CPAP use in patients with obstructive sleep apnoea: a systematic review. Sleep Breath 2022; 26 (03) 1321-1332
- 82 Poirier J, George C, Rotenberg B. The effect of nasal surgery on nasal continuous positive airway pressure compliance. Laryngoscope 2014; 124 (01) 317-319 https://www.scopus.com/inward/record.uri?eid=2-s2.0-84895847843&doi=10.1002%2Flary.24131&partnerID=40&md5=cba24efbd941f77e89483095bb08c0e4 [Internet]
- 83 Stewart MG, Witsell DL, Smith TL, Weaver EM, Yueh B, Hannley MT. Development and validation of the Nasal Obstruction Symptom Evaluation (NOSE) scale. Otolaryngol Head Neck Surg 2004; 130 (02) 157-163
- 84 Ishii L, Godoy A, Ishman SL, Gourin CG, Ishii M. The nasal obstruction symptom evaluation survey as a screening tool for obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 2011; 137 (02) 119-123 https://www.scopus.com/inward/record.uri?eid=2-s2.0-79952009984&doi=10.1001%2Farchoto.2010.251&partnerID=40&md5=bfe9d21cb2340255f0007cfa8cfb7e48 [Internet]
- 85 O'Connor-Reina C, Rodriguez-Alcala L, Ignacio JM, Baptista P, Garcia-Iriarte MT, Plaza G. Assessment of Muscular Weakness in Severe Sleep Apnea Patients: A Prospective Study. Otolaryngol Head Neck Surg 2023; 169 (03) 725-733
- 86 Owens RL, Eckert DJ, Yeh SY, Malhotra A. Upper airway function in the pathogenesis of obstructive sleep apnea: a review of the current literature. Curr Opin Pulm Med 2008; 14 (06) 519-524 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3624763/pdf/nihms412728.pdf [Internet]
- 87 Malhotra A, Mesarwi O, Pepin J-L, Owens RL. Endotypes and phenotypes in obstructive sleep apnea. Curr Opin Pulm Med 2020; 26 (06) 609-614
- 88 Rizzatti FG, Mazzotti DR, Mindel J. et al. Defining Extreme Phenotypes of OSA Across International Sleep Centers. Chest 2020; 158 (03) 1187-1197
- 89 Iannella G, Magliulo G, Cammaroto G. et al. Effectiveness of drug-induced sleep endoscopy in improving outcomes of barbed pharyngoplasty for obstructive sleep apnea surgery: a prospective randomized trial. Sleep Breath 2022; 26 (04) 1621-1632 https://www.scopus.com/inward/record.uri?eid=2-s2.0-85120613240&doi=10.1007%2Fs11325-021-02528-4&partnerID=40&md5=d73a3c9ab406746a670ef1d511ad70f2 [Internet]
- 90 De Vito A, Carrasco Llatas M, Vanni A. et al. European position paper on drug-induced sedation endoscopy (DISE). Sleep Breath 2014; 18 (03) 453-465
- 91 De Vito A, Carrasco Llatas M, Ravesloot MJ. et al. European position paper on drug-induced sleep endoscopy: 2017 Update. Clin Otolaryngol 2018; 43 (06) 1541-1552 https://pubmed.ncbi.nlm.nih.gov/30133943/ cited 2022Jun8 [Internet]
- 92 Abdulatif J, Camacho M, Capasso R, Lugo Saldana R. Evaluación de las vías aéreas superiores. In: Dade Reyes. , editor. Manejo médico y quirúrgico de los trastornos respiratorios del sueño y ronquido. 1st ed. Panamá:: Jaypee Brothers Medical Publishing (P) Ltd.;; 2017. . p. 15-42
- 93 Pérez-Martín N, Bosco G, Navarro A. et al. Drug Induced Sleep Endoscopy Versus Awake Endoscopy in Retrolingual Obstruction Assessment in Obstructive Sleep Apnea Patients: A Comparative Study. J Craniofac Surg 2022; 33 (05) e499-e503
- 94 Victores AJ, Takashima M. Effects of nasal surgery on the upper airway: a drug-induced sleep endoscopy study. Laryngoscope 2012; 122 (11) 2606-2610
- 95 Bosco G, Pérez-Martín N, Morato M, Racionero MA, Plaza G. Nasal Surgery May Improve Upper Airway Collapse in Patients With Obstructive Sleep Apnea: A Drug-Induced Sleep Endoscopy Study. J Craniofac Surg 2020; 31 (01) 68-71 https://www.scopus.com/inward/record.uri?eid=2-s2.0-85071655226&doi=10.1097%2FSCS.0000000000005865&partnerID=40&md5=648b13dffec3935dd3ae676ae0e7c4f0 [Internet]
- 96 Orlandi RR, Kingdom TT, Hwang PH. et al. International Consensus Statement on Allergy and Rhinology: Rhinosinusitis. Int Forum Allergy Rhinol 2016; 6 (Suppl. 01) S22-S209 https://www.scopus.com/inward/record.uri?eid=2-s2.0-84959312900&doi=10.1002%2Falr.21695&partnerID=40&md5=3a5ab57b17dc88a53389eca01672e192 [Internet]
- 97 American Academy of Allergy Asthma & Immunology. Allergy Statistics [Internet]. 2022 [cited 2022 Dec 31]. Available from: https://www.aaaai.org/About/News/For-Media/Allergy-Statistics
- 98 Savouré M, Bousquet J, Jaakkola JJK, Jaakkola MS, Jacquemin B, Nadif R. Worldwide prevalence of rhinitis in adults: A review of definitions and temporal evolution. Clin Transl Allergy 2022; 12 (03) e12130
- 99 Colás C, Galera H, Añibarro B. et al. Disease severity impairs sleep quality in allergic rhinitis (The SOMNIAAR study). Clin Exp Allergy 2012; 42 (07) 1080-1087
- 100 Craig TJ, McCann JL, Gurevich F, Davies MJ. The correlation between allergic rhinitis and sleep disturbance. J Allergy Clin Immunol 2004; 114 (05) S139-S145
- 101 Charakorn N, Hirunwiwatkul P, Chirakalwasan N, Chaitusaney B, Prakassajjatham M. The effects of topical nasal steroids on continuous positive airway pressure compliance in patients with obstructive sleep apnea: a systematic review and meta-analysis. Sleep Breath 2017; 21 (01) 3-8 [Internet]
- 102 Meen EK, Chandra RK. The role of the nose in sleep-disordered breathing. Am J Rhinol Allergy 2013; 27 (03) 213-220
- 103 Kim S-D, Jung D-W, Lee J-W, Park J-H, Mun S-J, Cho K-S. Relationship between allergic rhinitis and nasal surgery success in patients with obstructive sleep apnea. Am J Otolaryngol 2021; 42 (06) 103079
- 104 McKeown P, O'Connor-Reina C, Plaza G. Breathing Re-Education and Phenotypes of Sleep Apnea: A Review. J Clin Med 2021; 10 (03) 471
- 105 Pal A, Martinez F, Akey MA. et al. Breathing rate variability in obstructive sleep apnea during wakefulness. J Clin Sleep Med 2022; 18 (03) 825-833
- 106 Deacon-Diaz NL, Sands SA, McEvoy RD, Catcheside PG. Daytime loop gain is elevated in obstructive sleep apnea but not reduced by CPAP treatment. J Appl Physiol 2018; 125 (05) 1490-1497
- 107 Messineo L, Taranto-Montemurro L, Azarbarzin A. et al. Breath-holding as a means to estimate the loop gain contribution to obstructive sleep apnoea. J Physiol 2018; 596 (17) 4043-4056
- 108 Pham LV, Schwartz AR, Polotsky VY. Integrating loop gain into the understanding of obstructive sleep apnoea mechanisms. J Physiol 2018; 596 (17) 3819-3820
- 109 Guilleminault C, Huseni S, Lo L. A frequent phenotype for paediatric sleep apnoea: short lingual frenulum. ERJ Open Res 2016; Jul 29; 2 (03) 00043-2016 . PMID: 27730205; PMCID: PMC5034598