The role of Single-sited combined nasal and uvulopalatopharyngoplasty surgery in obstructive sleep apnea syndrome: integrating anatomy-based selection with advanced statistical outcomes.

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.