Concha Nasalis Inferior Uzamasının Obstrüktif Uyku Apne Sendromu ile İlişkisi

Öz

Amaç: Üst hava yolunun anatomik yapısı, obstrüktif uyku apne sendromunun (OUAS) patofizyolojisinde önemli bir rol oynamaktadır. Önceki çalışmaların büyük bir bölümü farengeal ya da kraniyofasiyal faktörlere odaklanmış olup, inferior nazal konkaya ait ayrıntılı morfometrik veriler sınırlıdır. Bu çalışmanın amacı, OUAS tanılı hastalarda concha nasalis inferior’un morfolojik ve morfometrik özelliklerini değerlendirmek ve bu bulguların koanal uzanım ile ilişkisini incelemektir.

Materyal ve metod: Polisomnografi ile OUAS tanısı doğrulanan 82 hastaya (41 kadın, 41 erkek) ait kraniyal BT görüntüleri retrospektif olarak analiz edildi. Üç boyutlu multiplanar rekonstrüksiyon kullanılarak inferior nazal konkanın maksimum anteroposterior uzunluğu bilateral olarak ölçüldü ve posterior koanal uzanım varlığı kaydedildi. Tüm ölçümler taraf ve cinsiyete göre analiz edildi ve bulgular koanal uzanım varlığına göre istatistiksel olarak karşılaştırıldı.

Bulgular: Her iki tarafta da concha nasalis inferior uzunluğu açısından kadınlar ve erkekler arasında anlamlı bir fark saptanmadı. Benzer şekilde, koanal uzanım sıklığı da cinsiyetler arasında anlamlı farklılık göstermedi. Buna karşılık, hem kadınlarda hem erkeklerde ve her iki tarafta, koanaya uzanım gösteren olgularda concha nasalis inferior uzunluğunun, uzanım göstermeyenlere göre anlamlı derecede daha uzun olduğu bulundu (p<0,05). Yaş ile konka uzunluğu arasında anlamlı bir ilişki saptanmadı.

Sonuç: Bu çalışmanın bulguları, OUAS’lı hastalarda concha nasalis inferior uzunluğunun cinsiyet ve yaş ile ilişkili olmadığını, ancak posterior koanal uzanım ile yakından ilişkili olduğunu göstermektedir. Daha uzun concha nasalis inferior’un koanaya doğru uzanım gösterme olasılığının daha yüksek olduğu ve bunun posterior nazal hava yolunun daralmasına katkıda bulunabileceği düşünülmektedir.

Anahtar Kelimeler

• Obstrüktif Uyku Apne Sendromu (OUAS)
• Concha Nasalis Inferior
• Bilgisayarlı tomografi

Inferior Nasal Concha Elongation Is Associated with Obstructive Sleep Apnea Syndrome

Öz

Background: Upper airway anatomy plays a crucial role in the pathophysiology of obstructive sleep apnea syndrome (OSAS). Most previous studies have focused on pharyngeal or craniofacial factors, while detailed morphometric data regarding the inferior nasal concha remain scarce. The aim of this study was to evaluate the morphology and morphometry of the inferior nasal concha in patients with OSAS and to examine its relationship with posterior choanal extension.

Materials and Methods: Retrospective cranial CT images of 82 polysomnography-confirmed OSAS patients (41 females, 41 males) were analyzed. Using three-dimensional multiplanar reconstruction, the maximum anteroposterior length of the inferior nasal concha was measured bilaterally, and posterior choanal extension was recorded. All measurements were analyzed by side and sex and statistically compared according to choanal extension.

Results: There was no significant difference in inferior nasal concha length between males and females on either side. Similarly, the frequency of choanal extension did not differ significantly between sexes. However, in both males and females, on both sides, the inferior nasal concha was significantly longer in cases with choanal extension than in those without (p<0.05). No significant association was found between age and conchal length.

Conclusions: The findings of this study indicate that, in patients with OSAS, inferior nasal concha length is not associated with sex or age but is closely related to posterior choanal extension. A longer inferior nasal concha appears more likely to project into the choana, which may contribute to posterior nasal airway narrowing. However, because this study did not include a non-OSAS control group, these findings should be interpreted as anatomical associations within an OSAS cohort rather than as OSAS-specific morphological features.

Anahtar Kelimeler

• Obstructive Sleep Apnea Syndrome (Osas)
• Inferior Nasal Concha
• Computed tomography

Kaynakça

1. 1. Garvey J, Pengo MF, Drakatos P, Kent BD. Epidemiological aspects of obstructive sleep apnea. J Thorac Dis. 2015;7(5):920.
2. 2. Kapur VK. Obstructive sleep apnea: diagnosis, epidemiology, and economics. Respir Care. 2010;55(9):1155.
3. 3. Sarkar P, Mukherjee S, Chai-Coetzer CL, McEvoy RD. The epidemiology of obstructive sleep apnoea and cardiovascular disease. J Thorac Dis. 2018;10.
4. 4. McNicholas WT. The nose and OSA: variable nasal obstruction may be more important in pathophysiology than fixed obstruction. Eur Respir J. 2008;32(1):3.
5. 5. Kohler M, Bloch KE, Stradling J. The role of the nose in the pathogenesis of obstructive sleep apnoea and snoring. Eur Respir J. 2007;30(6):1208.
6. 6. Özer CM, Öz İİ, Şerifoğlu İ, Büyükuysal Ç, Barut Ç. Evaluation of Eyeball and Orbit in Relation to Gender and Age. J Craniofac Surg. 2016;27(8).
7. 7. Bakırcı S, Öner S, Kıran H. Comparison of sphenoid sinus variations and morphometric values in dolichocephalic and hyperbrachycephalic individuals. Acta Radiol. 2025;66(6):650.
8. 8. Özer CM, Atalar K, Öz İİ, Toprak S, Barut Ç. Sphenoid Sinus in Relation to Age, Gender, and Cephalometric Indices. J Craniofac Surg. 2018;29(8):2319.

9. 9. Sahin-Yilmaz A, Naclerio RM. Anatomy and Physiology of the Upper Airway. Proc Am Thorac Soc. 2011;8(1):31. 10. Geurkink NA. Nasal anatomy, physiology, and function. J Allergy Clin Immunol. 1983;72(2):123.
10. 11. Migueis DP, Thuler LCS, Lemes LN de A, Moreira CSS, Joffily L, Araújo-Melo MH de. Systematic review: the influence of nasal obstruction on sleep apnea. Braz J Otorhinolaryngol. 2016;82(2):223.
11. 12. Smith DH, Brook C, Virani S, Platt MP. The inferior turbinate: An autonomic organ. Am J Otolaryngol. 2018;39(6):771.
12. 13. Nurse LA, Duncavage JA. Surgery of the Inferior and Middle Turbinates. Otolaryngol Clin North Am. 2009;42(2):295.
13. 14. Neskey DM, Eloy JA, Casiano RR. Nasal, Septal, and Turbinate Anatomy and Embryology. Otolaryngol Clin North Am. 2009;42(2):193
14. 15. Magliulo G, Iannella G, Ciofalo A, Polimeni A, Vincentiis M DE, Pasquariello et al. Nasal pathologies in patients with obstructive sleep apnoea. Acta Otorhinolaryngol Ital. 2019;39(4):250.
15. 16. Georgalas C. The role of the nose in snoring and obstructive sleep apnoea: an update. Eur Arch Otorhinolaryngol. 2011;268(9):1365.
16. 17. Marks T, Maddux SD, Butaric LN, Franciscus RG. Climatic adaptation in human inferior nasal turbinate morphology: Evidence from Arctic and equatorial populations. Am J Phys Anthropol. 2019;169(3):498.
17. 18. Scott JR, Psaltis AJ, Wormald P. Vascular Anatomy of the Inferior Turbinate and Its Clinical Implications. Am J Rhinol Allergy. 2020;34(5):604.
18. 19. Turhan B, Kervancıoğlu P, Yalçın ED. The radiological evaluation of the nasal cavity,conchae and nasal septum volumes bystereological method:A retrospective cone-beam computed tomography study. Adv Clin Exp Med. 2019;28(8):1021.
19. 20. Sasani H, Özkan M, Çelik HH. Assessment of External Occipital Protuberance Morphometry in CT Scans: Implications for Determining Age and Sex. Int J Morphol. 2025;43(3):1011.
20. 21. Franklin KA, Lindberg E. Obstructive sleep apnea is a common disorder in the population-a review on the epidemiology of sleep apnea. J Thorac Dis. 2015;7(8):1311.
21. 22. Arx T von, Lozanoff S, Bornstein MM. Extraoral anatomy in CBCT - a literature review. Part 1: Nasoethmoidal region. Swiss Dent J. 2019;129(10):804.
22. 23. Buchanan A, Cohen R, Looney SW, Kalathingal S, Rossi SD. Cone-beam CT analysis of patients with obstructive sleep apnea compared to normal controls. Imaging Science in Dentistry . 2016;46(1):9.
23. 24. Hasoğlan ŞT, Aksoy S, Öz U, Rasmussen F, Kamiloğlu B, Orhan K. Comparison of nasal passage and palatal volume in obstructive sleep apnea patients and healthy individuals using cone beam computed tomography. Sleep And Breathing . 2025;29(5):305.
24. 25. Makkonen J, Tertti O, Rautiainen M, et al. Association between nasal airway minimal cross-sectional areas and obstructive sleep apnoea. European Journal of Orthodontics . 2023;45(6):788.
25. 26. Correa EJ, Conti DM, Moreno-Luna R, Sánchez-Gómez S, O’Connor-Reina C. Role of Nasal Surgery in Adult Obstructive Sleep Apnea: A Systematic Review. Sleep Science . 2024;17(3).
26. 27. Lunardi G, Giombi F, Pace GM, Cerasuolo M, Spriano G, Malvezzi L. Measuring Nasal Airway Resistance to Personalize Surgery for Nasal Obstruction in OSA Patients. Journal of Personalized Medicine . 2025;15(12):608.