A deviated septum is an anatomical variation where the nasal septum (the wall separating the nostrils) is displaced to one side. This displacement obstructs nasal airflow and makes breathing difficult. Obstructive sleep apnea (OSA) is a sleep disorder where the upper airway repeatedly collapses during sleep. Although distinct, a deviated septum and OSA frequently coexist. This article explores whether correcting the nasal structure can improve OSA symptoms.
Understanding Nasal Obstruction and Sleep Apnea
The nasal septum’s deviation restricts airflow, narrowing the upper respiratory tract. This obstruction forces a person to breathe through their mouth, especially during sleep. While nasal blockage causes difficulty breathing, it is not the primary cause of severe OSA.
The most serious OSA episodes occur lower in the throat (pharyngeal obstruction), where the tongue base and soft palate relax and collapse. Poor nasal breathing significantly worsens existing OSA. When the mouth opens, the lower jaw can drop, allowing the tongue to fall backward, increasing the likelihood of an airway collapse.
The restriction of nasal airflow also increases negative pressure within the pharynx during inhalation. This heightened suction force makes throat tissues more prone to collapsing, leading to more frequent or severe apnea events. Therefore, a deviated septum acts as an exacerbating factor, complicating the underlying sleep apnea disorder.
Septoplasty as a Treatment for Airway Function
Septoplasty is the surgical procedure designed to correct a deviated septum by straightening the displaced bone and cartilage. The primary goal is to maximize the nasal airway’s physical capacity, restoring smooth and unrestricted airflow. Improving the efficiency of nasal breathing can reduce the severity of snoring.
For patients with OSA, improving nasal airflow impacts how they tolerate other treatments. Continuous Positive Airway Pressure (CPAP) therapy, the most common OSA treatment, requires effective nasal breathing for success. Septoplasty can decrease nasal resistance, potentially reducing the pressure required from the CPAP machine to keep the airway open.
This improvement in nasal patency is helpful for patients who find CPAP difficult to use due to a blocked nose. Reducing nasal obstruction dramatically improves a patient’s ability to tolerate and consistently use their CPAP device. Doctors often select patients for septoplasty when nasal obstruction contributes significantly to sleep disturbance or CPAP non-adherence.
Why Septoplasty is Not Always a Standalone Cure
Septoplasty alone rarely cures moderate or severe OSA because the condition is typically a multi-level disorder involving the tongue, soft palate, and throat walls. Correcting the nasal passage only addresses the highest point of obstruction in the airway. While this improves breathing, it usually does not resolve the collapse occurring lower in the pharynx.
OSA severity is determined by the Apnea-Hypopnea Index (AHI), measured via a sleep study (Polysomnography). Studies show that septoplasty can improve subjective symptoms like daytime sleepiness and quality of life. However, it often does not produce a clinically significant reduction in the objective AHI score, meaning isolated nasal surgery is not recommended as a first-line treatment.
Septoplasty functions best as an adjunctive therapy, used to make the standard treatments for OSA more effective. Standard treatments include CPAP therapy, oral appliances that reposition the jaw, and lifestyle modifications such as weight loss. By clearing the nasal passage, septoplasty helps patients achieve better adherence to CPAP and improves the success of other interventions. Combining septoplasty with other treatments offers the best path toward managing complex obstructive sleep apnea.