Prevalence of obstructive sleep apnea and anatomical variations of sinuses in patients with rhinosinusitis: A cross-sectional study

ABSTRACT Background: Anatomical variations of the maxillary sinus and nasal aperture, such as Haller cells, concha bullosa, osteomeatal complex blockage, and uncinate process attachment, can obstruct sinus drainage, leading to secretion retention, infection, and chronic sinusitis. Obstructive sleep apnea (OSA), characterized by reduced or absent airflow despite respiratory effort, may result from obesity, temporomandibular joint disorders, or rhinosinusitis. Aim: This study aimed to evaluate the prevalence of OSA in patients with chronic rhinosinusitis and to assess the prevalence of Haller cells, hypertrophied concha bullosa, blockage of the osteomeatal complex, and attachment types of the uncinate process in these patients. Materials and Methods: Thirty-one patients who met the inclusion and exclusion criteria were evaluated using a clinical examination and the STOP-BANG questionnaire to determine the prevalence of OSA. All patients underwent cone-beam computed tomography (CBCT) imaging using the Planmeca ProMax® 3D Max Romexis (version 5.3.0.1015, Planmeca, Helsinki, Finland) with parameters of 90 kVp, 10 mA, an exposure time of 36 s, and a field of view of 20 cm × 17.4 cm. The CBCT scans were analyzed bilaterally for the presence of Haller cells, hypertrophied concha bullosa, attachment type of the uncinate process, and blockage of the osteomeatal complex. Findings were recorded in a data sheet and statistically analyzed. Results: The study found a higher prevalence of OSA in patients with chronic rhinosinusitis compared with the general population. The prevalence increased with age, and males were at greater risk. Haller cells were present in 96.8% of cases, concha bullosa in 87.1%, and osteomeatal complex blockage in 80.6%. The type of uncinate process attachment varied, with lamina papyracea being most common on the left side and middle turbinate attachment most common on the right. Anatomical variations showed no statistically significant association with chronic rhinosinusitis. Conclusion: This study demonstrated a direct relationship between chronic rhinosinusitis and OSA, highlighting the higher prevalence of OSA in chronic rhinosinusitis patients. Although anatomical variations negatively correlated with chronic rhinosinusitis, they contributed to its pathogenesis but were unlikely to be the primary cause.