Septoplasty is a surgical procedure designed to straighten the septum, the large flat piece of cartilage that divides the nose into two chambers. In many cases of deviated septum, one of the nasal turbinates -- bony ridges in the upper nasal airway -- grows too large, and is often surgically reduced when the septoplasty is performed. Septoplasty and turbinate reduction can have an impact on obstructive sleep apnea and the Continuous Positive Airway Pressure, or CPAP, therapy that is used to treat it.
Obstructive Sleep Apnea
Deviated septum and the associated enlargement of a nasal turbinate are sometimes contributing causes of sleep apnea. Structurally, the septum narrows the nasal passage on the side to which it deviates; the turbinate on the opposite side of the nose enlarges, blocking off the air passage on that side. This narrowing can increase the likelihood that the nasal airway can be blocked off in sleep. Alternatively, it may force the patient to breath through the mouth, where a sagging upper palate can block off breathing. For this reason, septoplasty is sometimes used as an alternative or complementary treatment for sleep apnea.
Post-Surgical CPAP
Following septoplasty, patients typically must avoid placing pressure on the bridge of the nose for six to eight weeks after the surgery, to allow the septum, turbinate and associated structures to heal. This often means that sleep apena patients cannot use a common nasal CPAP mask immediately after septoplasty, because these masks press against the nose in order to form an air seal. Patients must either discontinue CPAP therapy until the septum has adequately healed, or use an oral or full-face mask during that time.
Improving the Effectiveness of CPAP
Sleep apnea patients suffering from septum deviation often have difficulty adjusting to CPAP treatment, which usually requires the patient to breath through his nose during sleep. Because of the airway blockage caused by the deviated septum and enlarged turbinate, the patient may feel as if he can't get enough air while on CPAP. Switching to an oral or full-face mask simply isn't an option for some CPAP users, because pressurizing the air in the mouth can cause the patient to swallow air, causing to bloating and stomach pain. For these patients, doctors perform septoplasty to allow them to get adequate air while using a standard nasal CPAP mask.
Eliminating the Need for CPAP
In some cases, correcting septum deviation allows the patient to breath through his nose rather than the mouth, and this change can sometimes eliminate sleep apnea. However, most sleep apnea patients will continue to need CPAP therapy, even after septoplasty.
References
- MayoClinic.com; Deviated Septum; July 2011
- LaserSeptoplasty.com: Sleep Apnea
- CareAllies; Rhinoplasty/Septoplasty; 2005
- Archives of Otolaryngology; Improvement in Quality of Life After Nasal Surgery Alone for Patients With Obstructive Sleep Apnea and Nasal Obstruction; Hsueh-Yu Li, et. al.; April 2008
