Day One Postoperative Use of CPAP Well Tolerated in Sinonasal Surgery Patients

What is sinonasal surgery patients’ tolerability level when restarting continuous positive airway pressure (CPAP) immediately postoperatively?

BOTTOM LINE: Combined with a lack of significant complications, CPAP appears to be well tolerated when restarted the day after a septoplasty/turbinectomy or functional endoscopic sinus surgery (FESS).

BACKGROUND: The mainstay treatment for obstructive sleep apnea (OSA) is CPAP. Some OSA patients receive nasal surgery to help them tolerate CPAP, and some OSA patients on CPAP require nasal or sinus surgery for non-OSA conditions. There are currently no evidence-based recommendations regarding the risks and optimal timing of CPAP reinitiation after sinonasal surgery.

STUDY DESIGN: Prospective cohort study.

SETTING: Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Penn.

SYNOPSIS: Researchers identified 14 otolaryngology patients who presented at a tertiary-care institution with a history of OSA, were compliant in using auto-titrating CPAP, and were scheduled for sinonasal surgery. Nine patients underwent FESS, and five underwent septoplasty/turbinectomy. All subjects were instructed to restart CPAP on the first postoperative night. Memory card data from each patient’s CPAP was obtained prior to, on the day of, and at scheduled intervals after surgery. Sino-Nasal Outcome Test (SNOT) and Nasal Obstruction Symptom Evaluation (NOSE) scores were obtained at the same time points. Participants used a visual analog scale to rate their CPAP tolerance and an activity log to document CPAP nonuse during the first postoperative week. There were no postoperative complications. There was a reduction in the percentage of nights CPAP was used over four hours in the first week, but by the third postoperative visit, average SNOT, NOSE, and CPAP tolerance scores improved from preoperative values. Authors cite the fact that the study design did not allow for daily assessment of CPAP usage as a limitation.

CITATION: Reilly EK, Boon MS, Vimawala S, et al. Tolerance of continuous positive airway pressure after sinonasal surgery [published online ahead of print September 16, 2020]. Laryngoscope. doi:10.1002/lary.28968.