Can a deviated septum cause Obstructive Sleep Apnea (OSA)?

Deviated Septum and Obstructive Sleep Apnea

A deviated septum can contribute to obstructive sleep apnea (OSA) but is rarely the primary cause of OSA by itself. While nasal obstruction from a deviated septum can worsen sleep-disordered breathing, evidence shows that nasal surgery alone is not recommended as a primary treatment for OSA 1.

Relationship Between Nasal Obstruction and OSA

Pathophysiological Connection

• Nasal obstruction promotes mouth breathing during sleep, which:
  • Creates more negative intraluminal pressure in the pharynx
  • Predisposes to pharyngeal occlusion and OSA events 1
  • Reduces upper airway dilator muscle activity compared to nasal breathing 1

Evidence from Studies

• Experimental nasal obstruction studies demonstrate:
  • Increased arousals
  • More frequent sleep stage changes
  • Increased obstructive apneas and hypopneas 1
  • Four-fold increase in both central and obstructive apneas when nasal airflow is blocked 1

Specific Findings on Deviated Septum in OSA

• Recent research (2025) found that anterior nasal septal deviation angle was significantly greater in OSA patients (9.1° ± 0.7°) compared to non-OSA patients (6.5° ± 0.5°) 2
• Multiple logistic regression showed anterior deviation as the only significant independent OSA predictive factor 2

Clinical Implications and Management

Surgical Correction of Deviated Septum

• Septoplasty as a single intervention is not recommended for primary treatment of OSA (Evidence Level C) 1
• Septoplasty is recommended for:
  • Reducing high therapeutic CPAP pressure due to nasal obstruction 1, 3
  • Improving CPAP adherence and effectiveness 3
  • Potentially reducing AHI scores and improving oxygen saturation in selected patients 3

Patient Selection for Surgery

• Best candidates for septoplasty in OSA management:
  • Patients with documented nasal obstruction due to septal deviation 3
  • Those with CPAP intolerance related to nasal obstruction 3
  • Patients with normal cephalometric measurements may show more improvement 1

Evaluation Process

• Recommended workup before considering septoplasty:
  • Formal sleep study to evaluate for OSA 3
  • Acoustic rhinometry and nasal endoscopy 3
  • Patient-reported outcome measures of nasal obstruction 3
  • 4-week trial of appropriate medical therapy (intranasal corticosteroids, saline irrigation) 3

Limitations and Caveats

Surgical Outcomes

• Only two studies reported significant improvements in respiratory disturbances after nasal surgery 1
• Most patients show residual sleep-disordered breathing even after successful nasal surgery 1
• Improvement in subjective sleepiness and daytime energy levels is more common than objective OSA improvement 1

Risk Factors for Poor Outcomes

• Abnormal cephalometric measurements predict poor response to isolated nasal surgery 1
• Other anatomical factors (enlarged tongue, thick soft palate, hypertrophic tonsils) are stronger correlates with OSA severity 1
• Incidence of severe surgical complications is approximately 0.5%, with about 10% requiring revision surgery within 3 years 3

Bottom Line

While a deviated septum can contribute to OSA by causing nasal obstruction and promoting mouth breathing, it is rarely the sole cause of OSA. Surgical correction of a deviated septum should not be considered a primary treatment for OSA but may be beneficial as an adjunctive therapy to improve CPAP compliance or in carefully selected patients with documented nasal obstruction.