Moderate OSAS and turbinate decongestion: surgical efficacy in improving the quality of life and compliance of CPAP using Epworth score and SNOT-20 score

摘要

Drug-induced sleep endoscopy (DISE) is an important procedure in diagnostic pathway of patients affected by moderate OSAS. However, the ItalianNational Health System does not provide any compatible Diagnosis-related-group (DRG) code codification for DISE, which makes it impossibleto obtain regional reimbursement. In order to overcome this problem, DISE is usually associated with other codified surgical procedures. Theaim of our study is to assess the association of turbinate decongestion (TD) and DISE in order to combine in a single operating session diagnosticand therapeutic procedures. The objective of our work is to assess the role of nasal surgery on symptoms of moderate OSA. Recent studies haveconfirmed that isolated nasal surgery improves quality of life (QOL), but not the apnoea hypopnoea index (AHI) during polygraph registration. Weenrolled 30 patients, aged between 29 and 64 years (mean 50.53 ± 9.20), 26 males and 4 females, with a mean BMI of 26.07 ± 2.81 kg/m2, whowere affected by moderate OSAS. All patients underwent otolaryngologycal pre-operative evaluation, home respiratory polygraph and subjectiveevaluation through Sino-Nasal-Outcome Test (SNOT-20) and Epworth Sleepiness Scale (ESS). During the same surgery session, they underwentDISE and TD. Patients were re-evaluated six months later using the same questionnaires. We observed a significant improvement (p < 0.05) in boththe mean ESS index (6.03 ± 2.75 vs 4.16 ± 4.63) and total SNOT score (22.53 ± 12.16 vs 13.23 ± 10.82). Significant differences (p < 0.05) werealso identified for partial SNOT questions 1-11 (9.1 ± 5.11 vs 6.13 ± 4.12) and 11-20 (13.36 ± 10.20 vs 7.13 ± 9.644). The results of the presentstudy confirm that TD alone can improve sleepiness, QOL and nasal symptoms. Thus, in absence of a National Health System recognition forDISE, the association of this procedure with TD can be useful for diagnostic and therapeutic management of OSAS, improving CPAP complianceand adherence, reducing sleepiness, ameliorating nasal symptoms and therefore QOL.