SURGICAL-CORRECTION OF NASAL OBSTRUCTION IN THE TREATMENT OF MILD SLEEP-APNEA - IMPORTANCE OF CEPHALOMETRY IN PREDICTING OUTCOME

Background-A study was undertaken to determine if cephalometric radiog raphs could identify those who will benefit from nasal surgery in pati ents with a sleep apnoea hypopnoea syndrome (SAHS) and chronic nasal o bstruction. Methods-Fourteen patients with SAHS were enrolled. Those w ith normal posterior airway space and mandibular plane to hyoid bone d istances on preoperative cephalometric radiographs were matched with t hose with abnormal cephalometry for the frequency of sleep disordered breathing and body mass index. Polysomnographic studies (all subjects) and nasal resistance measurements (n = 10) were performed one to thre e months before and two to three months after surgery (septoplasty, tu rbinectomy, and polypectomy). Results-There was no difference in the b aseline results of the polysomnographic studies between the two groups of patients. Nasal resistance decreased from a mean (SE) value of 2.9 (0.3) cm H2O/l/S before surgery to 1.4 (0.1) cm H2O/l/s after surgery in the normal cephalometry group and from 2.7 (0.3) cm H2O/l/s to 1.3 (0.3) cm H2O/l/s in the other group. The apnoea + hypopnoea index ret urned to normal (<10 breathing abnormalities/hour) in all but one subj ect with normal cephalometric measurements, and sleep fragmentation im proved with a decrease in the arousal index from 23.9 (3-3)/hour at ba seline to 10.6 (2.5)/hour after surgery. Both of these parameters rema ined unchanged after surgery in the patients with abnormal cephalometr y. Conclusions-Normal cephalometry is helpful in identifying patients with mild SAHS and nasal obstruction who will benefit from nasal surge ry. The presence of craniomandibular abnormalities makes it unlikely t hat nasal surgery will improve sleep related breathing abnormalities.