Screening for this condition is simple and treatment may improve sleep-related symptoms and quality of life.
By Peter Blais, RPSGT
A deviated septum is rarely the sole cause of obstructive sleep apnea (OSA). But symptomatic nasal obstruction from a deviated septum, or any number of other causes, has clearly been shown to be an independent contributor and risk factor for snoring, OSA, poor sleep quality, and daytime sleepiness, according to Ryan Soose, MD, assistant professor in the Department of Otolaryngology at the University of Pittsburgh Medical Center (UPMC).
Furthermore, difficulty breathing through the nose contributes to poorer outcomes with CPAP and with oral appliance therapy.
A deviated septum is a common structural abnormality of the nasal cavity, Soose tells Dental Sleep Corner. The septum—the wall that divides the two sides of the nose—consists of both cartilage and bone. A deviated septum refers to a curved or crooked septum that can make it difficult to breathe through one or both sides of the nose.
Septoplasty, a common treatment, is a surgical procedure that repairs the deviated septum and so improves the airflow and symmetry of the two sides of the nose. For most patients, septoplasty is combined with a turbinate reduction procedure; it consists of an approximately 1-hour outpatient procedure under general anesthesia. Potential risk, recovery, discomfort, and downtime are low and manageable for the majority of patients.
“Although septoplasty rarely provides complete treatment of OSA, sinonasal surgery can substantially improve sleep-related symptoms and quality of life measures and can improve outcomes with CPAP and oral appliances,” Soose says.
Is a deviated septum something a general dentist can see/screen for? For most patients, Soose says, the most efficient and cost-effective way to screen for a deviated septum is simply asking patients whether they can breathe comfortably through their nose or have any other sinonasal complaints. A simple anterior nasal examination with a headlight and nasal speculum can provide additional anatomic information. Routine dental radiographs may also provide insight into structural nasal problems. More sophisticated imaging or endoscopic techniques are rarely needed for initial screening.
“I would encourage dentists to include a question about nasal breathing on the office intake form or implement a simple screening questionnaire such as the NOSE [nasal obstruction symptom evaluation] scale or SNQ,” Soose concludes. “OSA patients with a high clinical concern for sinonasal problems may be referred to an otolaryngology colleague for further evaluation and possible adjunctive nasal treatment.
Ryan Soose, MD
“An improved nasal airway has the potential to augment the effectiveness of oral appliance therapy. A multidisciplinary team approach with both sleep dentistry and otolaryngology likely yields better outcomes than either one in isolation.”
Soose is the director of the UPMC Division of Sleep Medicine and Upper Airway Surgery and assistant professor in the Department of Otolaryngology at UPMC. He earned his undergraduate degree from the University of Notre Dame and completed medical and surgical training at UPMC. Board-certified in both otolaryngology and sleep medicine, Soose specializes in the medical and surgical treatment of snoring and OSA. He is an appointed member of the Sleep Disorders Committee of the American Academy of Otolaryngology and is an active member of the American Academy of Sleep Medicine (AASM) and the International Surgical Sleep Society (ISSS). He has a special interest in sedated endoscopy and neurostimulation therapy in the management of patients with sleep apnea.
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