Der Einfluss von funktioneller Rhinochirurgie bei bestehender Nasenpathologie auf die Verbesserung der Maskentoleranz bei Patienten mit obstruktivem Schlafapnoe-Syndrom

Abstract

Objective: The CPAP therapy is the gold standard in treating OSA. However, long-term compliance is severely limited in patients with obstructive nasal breathing. This study investigated the possibility of improving mask compliance aided by functional rhinosurgery (FR). Material: 49 patients with obstructive nasal pathologies were retrospectively examined. 25 received FR (group A), 24 served as control (group B). Parameters evaluated pre- and post-operatively were: ventilation pressure, wearing time and rhinomanometry. Additionally the Beck Depression Inventory (BDI) and Epworth-Sleepiness-Scale (ESS) assessed the quality of life. Results: The average ventilation pressure before surgery was 10,08 mbar (± 3,7) and post-op 9,08 mbar (± 3.2) (p = 0.019). Group B vs. A pre-op showed no significant differences (p = 0.122), compared to post-op values which were statistically highly significant (p = 0.006). Wearing time was 3.48 nights per week and increased post-op to 6.32, which was highly significant (p < 0.001). The control group wore the mask only 3.48 h/night. The rhinomanometry improved signififcantly from 402.79 cm3/s to post-op 634.24 cm3/s (p = 0.006). In group B the average was 503,50 cm3/s. No statistical difference between group A pre-op vs. B (p = 0.058) and highly significant after surgery (p < 0.001). The BDI pre-op was 9.88 and decreased post-op to 6.33 (p = 0.52). In group B it was 5.7 ± 4,9. After surgery, there was no statistical difference between groups A and B (p = 0.49). The Epworth-Sleepiness-Scale (ESS) improved from pre-op 11,05 to post-op significantly to 7.46 (p = 0.004). In group B it was 6.39. Group A post-op compared to group B showed no statistical significant difference (p = 0.345). Conclusion: In patients with nasal breathing pathologies and OSA, FR can decrease significantly ventilation pressure, prolong wearing time, decrease rhinomanometry and improve subjective therapy success with significantly improved compliance.