title: Does Nasal Surgery Improve OSA in Patients with Nasal Obstruction and OSA? A Meta-analysis.
abstract: OBJECTIVE
  To perform a systematic review and meta-analysis to determine if isolated nasal surgery in patients with obstructive sleep apnea and nasal airway obstruction improves obstructive sleep apnea.
  
  
  METHODS
  Computerized searches were performed in PubMed, EMBASE, and the Cochrane Library through October 2014. Manual searches and subject matter expert input was also solicited.
  
  
  METHODS
  A search protocol was defined a priori, and 2 independent investigators performed the data extraction, focusing on relevant data, including quality data polysomnography data, and taking note of methodological quality and risk for bias.
  
  
  RESULTS
  The 10 studies meeting criteria included a total of 320 patients. There were 2 randomized controlled trials, 7 prospective studies, and 1 retrospective study. There was a significant improvement in the pooled results of both Epworth Sleepiness Scale (ESS; difference 3.53, 95% confidence interval [CI] [0.64, 6.23]) and Respiratory Disturbance Index (RDI; 11.06, 95% CI [5.92, 16.19]) scores with isolated nasal surgery. There was no significant improvement in the Apnea Hypopnea Index (AHI) in the random effects model (4.83, 95% CI [-1.6, 11.62]).
  
  
  CONCLUSIONS
  The pooled results showed that isolated nasal surgery for patients with nasal obstruction and obstructive sleep apnea improved some sleep parameters, as shown by significant improvements in ESS and RDI, but had no significant improvements on AHI. Future controlled studies with larger groups are needed to confirm the benefits of isolated nasal surgery in this patient population.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA learnes2@jhmi.edu.
authors.forename: Lisa
authors.initials: L
authors.lastname: Ishii
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Chris
authors.initials: C
authors.lastname: Roxbury
authors.affiliation: San Francisco, California, USA.
authors.forename: Andres
authors.initials: A
authors.lastname: Godoy
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Cincinnati Childrens Hospital, Cincinnati, Ohio, USA.
authors.forename: Stacey
authors.initials: S
authors.lastname: Ishman
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Masaru
authors.initials: M
authors.lastname: Ishii
mesh_terms: D006801:Humans; D015508:Nasal Obstruction / Q000601:surgery*; D017286:Polysomnography; D011788:Quality of Life; D020181:Sleep Apnea, Obstructive / Q000601:surgery*
keywords: nasal obstruction; nasal surgery; obstructive sleep apnea; sleep apnea