European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery · 2025
The role of Single-sited combined nasal and uvulopalatopharyngoplasty surgery in obstructive sleep apnea syndrome: integrating anatomy-based selection with advanced statistical outcomes.
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Aliyeva Aynur, Huseynzada Sinakhanim, Hashimli Ramil, Yılmaz Bayram
Аннотация
PURPOSE: To evaluate the clinical efficacy and outcomes of a single-stage surgical approach combining nasal surgery and uvulopalatopharyngoplasty (UPPP) in patients with obstructive sleep apnea syndrome (OSAS) and nasal obstruction.
METHODS: Fifty adult patients with OSAS and anatomical nasal obstruction underwent single-stage UPPP with septoplasty and conchoplasty. Pre- and postoperative evaluations included subjective symptom scoring, polysomnography, anterior active rhinomanometry (AAR), and the SF-36 quality of life questionnaire. Surgical success was defined as ≥ 50% reduction in apnea-hypopnea index (AHI) and postoperative AHI < 20. Patients were classified using the Friedman anatomical staging system. Statistical analyses included paired t-tests, ANCOVA, logistic regression, effect sizes (Cohen's d), and Bonferroni correction.
RESULTS: Mean AHI improved significantly from 50.1 ± 17.4 to 18.8 ± 19.6 events/hour (p < .001). Surgical success and response rates were 62.0% and 72.0%, respectively. Stage-specific success was highest in Stage I (68.4%) and lowest in Stage III (46.2%). Significant reductions were observed in nasal resistance (from 0.46 ± 0.08 to 0.27 ± 0.06 Pa/cm³/s; p < .001) and ESS scores (from 11.2 ± 3.7 to 5.8 ± 2.7; p < .001). All SF-36 domains improved postoperatively. Effect sizes for key parameters were large (Cohen's d > 1.0), and all p-values remained significant after adjustment.
CONCLUSION: Single-stage UPPP combined with nasal surgery is a safe and effective treatment for OSAS patients with nasal obstruction. Anatomical staging plays a key role in predicting surgical outcomes. Objective airflow, sleep indices, and quality-of-life measures confirm the clinical value of this integrated approach.
METHODS: Fifty adult patients with OSAS and anatomical nasal obstruction underwent single-stage UPPP with septoplasty and conchoplasty. Pre- and postoperative evaluations included subjective symptom scoring, polysomnography, anterior active rhinomanometry (AAR), and the SF-36 quality of life questionnaire. Surgical success was defined as ≥ 50% reduction in apnea-hypopnea index (AHI) and postoperative AHI < 20. Patients were classified using the Friedman anatomical staging system. Statistical analyses included paired t-tests, ANCOVA, logistic regression, effect sizes (Cohen's d), and Bonferroni correction.
RESULTS: Mean AHI improved significantly from 50.1 ± 17.4 to 18.8 ± 19.6 events/hour (p < .001). Surgical success and response rates were 62.0% and 72.0%, respectively. Stage-specific success was highest in Stage I (68.4%) and lowest in Stage III (46.2%). Significant reductions were observed in nasal resistance (from 0.46 ± 0.08 to 0.27 ± 0.06 Pa/cm³/s; p < .001) and ESS scores (from 11.2 ± 3.7 to 5.8 ± 2.7; p < .001). All SF-36 domains improved postoperatively. Effect sizes for key parameters were large (Cohen's d > 1.0), and all p-values remained significant after adjustment.
CONCLUSION: Single-stage UPPP combined with nasal surgery is a safe and effective treatment for OSAS patients with nasal obstruction. Anatomical staging plays a key role in predicting surgical outcomes. Objective airflow, sleep indices, and quality-of-life measures confirm the clinical value of this integrated approach.