In-Office Treatment of Mild OSA

Clinical History: Pt presented with a diagnosis of Mild OSA. CPAP was prescribed by the referring physician at a pressure of 8 cm H20 but the patient felt that such treatment was too extreme given the mild level of OSA. The patient’s Body Mass Index was 24.8, which is in the normal range. Seeking further options, the patient presented to GNO Snoring and Sinus.

Physical Exam: A full airway examination in the office revealed significant blockage at the nasal airway. The palate and tongue were both quite normal. Further discussion with the patient revealed a history of chronic nasal congestion and sinus infections. The patient felt that sleep was always worse during bouts of sinusitis – with significant difficulty breathing through the nose.

Treatment: The patient underwent in-office balloon sinuplasty to improve sinus drainage and nasal airflow, given the diagnosis of chronic sinusitis.

Results:

Pre-op Sleep Study (6/2015)
Apnea Hypopnea Index (AHI): 9.7 (Mild OSA)
BMI: 24.8 (Normal)

In-Office Procedure(9/2015): In-Office Balloon Sinuplasty
Post-op Sleep Study (10/2015)
Apnea Hypopnea Index(AHI): 0
BMI: 24.8

Summary: Following the in-office procedure, the patient noted a significant improvement in breathing and daytime energy. Furthermore, sleep was more restful with improved breathing through the nasal airway, and decreased sinus pressure. The post procedure sleep study revealed a Total Cure of Sleep Apnea. Therefore, given the subjective improvement in sleep and breathing, and the restoration of this patient’s AHI to a normal level – effectively curing the sleep apnea – CPAP therapy was no longer required in this individual.

FootNote: This patient represents a growing subset of individuals we see at GNO Snoring and Sinus – Patients who are not overweight by BMI metrics, yet are diagnosed with Sleep Apnea and prescribed CPAP therapy for mild levels of Sleep Apnea. These patients are more likely to have correctable airway obstructions leading to a cure of their Sleep Apnea. A full airway assessment should be performed in all patients with sleep apnea prior to initiating CPAP therapy, but most importantly in this population – given their higher cure rate.