Holistic care for obstructive sleep apnea (OSA) with an emphasis on restoring nasal breathing - A review and perspective

Sep 29, 2026

Uploaded by Kyle

Obstructive sleep apnea (OSA) involves partial or complete airway blockage during sleep. Nocturnal nasal obstruction commonly promotes mouth breathing, which aggravates tongue-base and lateral pharyngeal wall collapse and worsens OSA. Although CPAP is first-line, adherence remains difficult; alternatives include oral appliances for simple snoring or mild OSA and maxillomandibular advancement for mandibular retrognathia with moderate-to-severe disease. Intrapharyngeal surgery can help selected patients but benefits may decline over time, supporting multimodality treatment guided by patient factors. Nasal surgery is central to holistic care by reducing congestion, snoring intensity and daytime sleepiness, and may improve CPAP compliance, while its effect on AHI is still debated.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

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Introduction

Etiology of OSA

. J Chin MedAssoc Review ARticle Holistic care for obstructive sleep apnea (OSA) with an emphasis on restoring nasal breathing: A review and perspective Ming-Shao Tsaia,b,c,d, Hung-Chin Chena,b, Stanley Yung-Chuan Liue, Li-Ang Leeb,f, Cheng-Yu Ling,h,i, Geng-He Changa,b,c,d, Yao-Te Tsaia,b, Yi-Chan Leeb,j, Cheng-Ming Hsua,b, Hsueh-Yu Lib,f,* aDepartment of Otolaryngology—Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC; bFaculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC; cGraduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC; dHealth Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC; eDivision of Sleep Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA; fDepartment of Otolaryngology—Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC; gDepartment of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC; hDepartment of Environmental and Occupational Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC; iSleep Medicine Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC; jDepartment of Otolaryngology—Head and Neck Surgery, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan, ROC Abstract: Obstructive sleep apnea (OSA) is characterized by partial or complete airway blockage during sleep. Nocturnal nasal obstruction usually leads to mouth breathing while sleeping, which worsens sleep apnea by aggravating tongue base and lateral pharyngeal wall collapse. The pathogenesis of OSA is multifactorial, and the precipitating factors vary significantly among individuals. Although continuous positive airway pressure (CPAP) is considered the first-line therapy for OSA, its adherence rate remains a challenge. Oral appliances are more suitable for simple snorers or patients with mild OSA. Maxillomandibular advancement (MMA) is highly effective for treating those with mandibular retrognathia and moderate-to-severe OSA. Intrapharyngeal surgeries yield favorable outcomes in patients with large tonsils and low tongue resting position (Friedman Stage I); however, their efficacy declines with time. Each therapy has its own strength and weakness; thus, the principle of multimodality treatment should be adopted. Nasal surgery plays an indispensable role in the holistic care for OSA. In addition to alleviating nasal congestion, nasal surgery significantly reduces snoring intensity and daytime sleepiness, which improves the quality of life of patients with OSA. Although it significantly reduces the respiratory disturbance index, its effect on the apnea– hypopnea index remains controversial. A combination of nasal surgery and multilevel pharyngeal surgery may result in better prognosis. Nasal surgery can significantly reduce the therapeutic pressure and improve the CPAP compliance of patients undergoing CPAP therapy. In conclusion, multimodality treatment and holistic care for OSA should involve nasal surgery for optimizing treatment outcomes. Keywords: Nasal surgery; Nose; Patency; Sleep apnea; Snoring 1. INTRODUCTION Nasal surgery, including correction of the deviated nasal septum and volume reduction of inferior turbinates, could be effective for improving nasal patency and restoring nasal breathing.1 In addition, it is helpful in mitigating daytime sleepiness and reducing snoring intensity.2 A decrease in nasal resistance consequently lowers the pressure level of continuous positive airway pressure (CPAP) therapy, which benefits CPAP *Address correspondence. Dr. Hsueh-Yu Li, Department of Otolaryngology—Head and Neck Surgery, Linkou Chang Gung Memorial H

FAQs

How does nocturnal nasal obstruction affect obstructive sleep apnea?

Nocturnal nasal obstruction typically leads to mouth breathing during sleep, which worsens OSA by aggravating tongue-base and lateral pharyngeal wall collapse.

What role does nasal surgery play in holistic OSA care?

Nasal surgery improves nasal breathing and reduces nasal congestion. It can significantly lessen snoring intensity and daytime sleepiness, improving patients’ quality of life and potentially reducing therapeutic pressure and improving CPAP compliance.

Why is multimodality treatment recommended for OSA?

Each therapy has distinct strengths and limitations, and OSA has multifactorial causes that vary by individual. The article emphasizes that integrating nasal surgery with other treatment approaches can yield better overall outcomes.

Sep 29, 2026

Uploaded by Kyle