Immediate Resumption of Positive Airway Pressure Following Sinus Surgery: A Prospective Controlled Multicenter Study

OBJECTIVE: Untreated obstructive sleep apnea (OSA) in the perioperative period confers significant cardiopulmonary risk. However, many otolaryngologists defer restarting positive airway pressure (PAP) therapy following functional endoscopic sinus surgery (FESS) due to perceived risk of epistaxis, mucosal injury, and wound healing. Thus, the objective of this study was to evaluate the immediate resumption of PAP therapy in OSA patients undergoing FESS. STUDY DESIGN: Multicenter prospective controlled study. SETTING: Academic medical centers. METHODS: Patients with a history of OSA on PAP therapy scheduled for FESS were prospectively enrolled (OSA/PAP group) along with a control group of non-OSA FESS patients (non-OSA group). Patients in the OSA/PAP group restarted PAP therapy on post-operative Day #0 or #1. The primary outcome was change in Lund-Kennedy endoscopic scores (LKES); secondary outcomes of interest included change in post-operative SNOT-22 scores, Pittsburgh Sleep Quality Index (PSQI) scores, complications, and epistaxis severity scores. RESULTS: A total of 100 patients were enrolled, of whom 49 were in the OSA/PAP group, and 51 were in the non-OSA group. In multivariate adjusted models, early PAP resumption was not independently associated with higher LKES compared to the control group at POV1 or POV2, higher SNOT-22 compared to the control group at POV1 or POV2, or higher postoperative epistaxis scores compared to the control group. There were no PAP-related complications such as orbital emphysema or pneumocephalus. CONCLUSION: Early resumption of PAP in OSA patients undergoing FESS does not appear to be associated with worsened post-operative endoscopic scores, quality-of-life scores, or an increased risk of post-operative epistaxis.