title: The effect of nasal surgery on continuous positive airway pressure device use and therapeutic treatment pressures: a systematic review and meta-analysis.
abstract: BACKGROUND
  The relationship between nasal surgery and its effect on continuous positive airway pressure (CPAP) device therapeutic treatment pressures and CPAP device use has not been previously systematically examined.
  
  
  OBJECTIVE
  To conduct a systematic review and meta-analysis evaluating the effect of isolated nasal surgery on therapeutic CPAP device pressures and use in adults with obstructive sleep apnea (OSA).
  
  
  METHODS
  MEDLINE, Scopus, Web of Science, and The Cochrane Library were searched through July 15, 2014. The MOOSE consensus statement and PRISMA statement were followed.
  
  
  RESULTS
  Eighteen studies (279 patients) reported CPAP data after isolated nasal surgery. Seven studies (82 patients) reported preoperative and postoperative mean therapeutic CPAP device pressures and standard deviations (SD), which reduced from 11.6 ± 2.2 to 9.5 ± 2.0 centimeters of water pressure (cwp) after nasal surgery. Pooled random effects analysis demonstrated a statistically significant pressure reduction, with a mean difference (MD) of -2.66 cwp (95% confidence interval (CI), -3.65 to -1.67); P < 0.00001. Eleven studies (153 patients) reported subjective, self-reported data for CPAP use; and a subgroup analysis demonstrated that 89.1% (57 of 64 patients) who were not using CPAP prior to nasal surgery subsequently accepted, adhered to, or tolerated it after nasal surgery. Objective, device meter-based hours of use increased in 33 patients from 3.0 ± 3.1 to 5.5 ± 2.0 h in the short term (<6 mo of follow-up).
  
  
  CONCLUSIONS
  Isolated nasal surgery in patients with OSA and nasal obstruction reduces therapeutic CPAP device pressures and the currently published literature's objective and subjective data consistently suggest that it also increases CPAP use in select patients.
authors.affiliation: Department of Psychiatry, Division of Sleep Medicine, Stanford Hospital and Clinics, Stanford, CA.
authors.forename: Macario
authors.initials: M
authors.lastname: Camacho
authors.affiliation: Department of Family and Community Medicine, University of California San Francisco, Fresno, CA.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Riaz
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Sleep Surgery Division, Stanford University Medical Center, Stanford, CA.
authors.forename: Robson
authors.initials: R
authors.lastname: Capasso
authors.affiliation: Department of Psychiatry, Division of Sleep Medicine, Stanford Hospital and Clinics, Stanford, CA.
authors.forename: Chad M
authors.initials: CM
authors.lastname: Ruoff
authors.affiliation: Department of Psychiatry, Division of Sleep Medicine, Stanford Hospital and Clinics, Stanford, CA.
authors.forename: Christian
authors.initials: C
authors.lastname: Guilleminault
authors.affiliation: Department of Psychiatry, Division of Sleep Medicine, Stanford Hospital and Clinics, Stanford, CA.
authors.forename: Clete A
authors.initials: CA
authors.lastname: Kushida
authors.affiliation: Department of Otorhinolaryngology, Hospital Lusiadas - Porto, Portugal; CINTESIS - Center for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal.
authors.forename: Victor
authors.initials: V
authors.lastname: Certal
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000379:methods* / Q000706:statistics & numerical data*; D006801:Humans; D059747:Nasal Surgical Procedures / Q000145:classification; D011184:Postoperative Period; D057234:Preoperative Period; D011312:Pressure; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy*; D016896:Treatment Outcome
keywords: continuous positive airway pressure; nasal surgery; obstructive sleep apnea; sleep apnea syndromes