{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T11:32:09Z","timestamp":1786620729431,"version":"build-2736575974"},"reference-count":21,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Sleep Research"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Nasal breathing is the preferred route of breathing during sleep. Indeed, nasal blockage can cause obstructive sleep apnoea (OSA) in otherwise healthy people. Whilst multi\u2010level pharyngeal surgery reduces OSA severity, efficacy varies and changes in OSA pathophysiology post\u2010surgery have not been well characterised. Similarly, whether isolated nasal surgery improves upper airway collapsibility and OSA severity remains unclear. Accordingly, this study aimed to assess changes in upper airway collapsibility and estimated OSA endotypes following nasal and multi\u2010level upper\u2010airway surgery. In\u2010laboratory polysomnography was performed pre\u2010 and post\u2010nasal or multi\u2010level upper airway surgery in 10 people with OSA. Brief (250\u2009ms) negative pressure pulses (~\u201012\u2009cmH\n                    <jats:sub>2<\/jats:sub>\n                    O) were also applied in early inspiration and early expiration during wakefulness to calculate the upper airway collapsibility index (UACI). Endotype changes were estimated from polysomnography. Multi\u2010level upper\u2010airway surgery reduced OSA severity with a corresponding 76% reduction in the UACI (38%\u2009\u00b1\u200926% vs. 9%\u2009\u00b1\u200919%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.02) during inspiration with similar improvements during expiration (69%\u2009\u00b1\u200936% vs. 21%\u2009\u00b1\u200931%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.01). Similarly, upper\u2010airway collapsibility and loop gain endotypes improved following multi\u2010level surgery. For isolated nasal surgery, OSA severity, upper\u2010airway collapsibility and OSA endotypes were not systematically different pre\u2010 versus post\u2010surgery. These findings indicate major improvements in upper\u2010airway collapsibility during wakefulness and sleep, and reductions in loop gain following multi\u2010level upper\u2010airway surgery but no systematic changes in key OSA pathophysiology\/severity measures following isolated nasal surgery, although the sample size for this comparison was small. Further application of these physiological measures may help explain, at least in part, between patient differences in therapeutic efficacy with different upper airway surgical approaches.\n                  <\/jats:p>","DOI":"10.1111\/jsr.70416","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T10:48:45Z","timestamp":1786618125000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Effects of Nasal and Multi\u2010Level Upper Airway Surgery on Upper Airway Collapsibility and Non\u2010Anatomical Endotypes in People With Obstructive Sleep Apnoea\u2014A Pilot Study"],"prefix":"10.1111","author":[{"given":"Amal M.","family":"Osman","sequence":"first","affiliation":[{"name":"Flinders Health and Medical Research Institute\/Adelaide Institute for Sleep Health Flinders University  Bedford Park South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7507-7983","authenticated-orcid":false,"given":"A. Simon","family":"Carney","sequence":"additional","affiliation":[{"name":"Flinders Health and Medical Research Institute\/Adelaide Institute for Sleep Health Flinders University  Bedford Park South Australia Australia"},{"name":"Flinders Private Hospital  Bedford Park South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Himani","family":"Joshi","sequence":"additional","affiliation":[{"name":"Flinders Health and Medical Research Institute\/Adelaide Institute for Sleep Health Flinders University  Bedford Park South Australia Australia"},{"name":"Flinders Private Hospital  Bedford Park South Australia Australia"},{"name":"Otolaryngology Head and Neck Surgery, Flinders Medical Centre  Bedford Park South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phuc","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Flinders Health and Medical Research Institute\/Adelaide Institute for Sleep Health Flinders University  Bedford Park South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Catcheside","sequence":"additional","affiliation":[{"name":"Flinders Health and Medical Research Institute\/Adelaide Institute for Sleep Health Flinders University  Bedford Park South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7201-815X","authenticated-orcid":false,"given":"Eng H.","family":"Ooi","sequence":"additional","affiliation":[{"name":"Flinders Health and Medical Research Institute\/Adelaide Institute for Sleep Health Flinders University  Bedford Park South Australia Australia"},{"name":"Flinders Private Hospital  Bedford Park South Australia Australia"},{"name":"Otolaryngology Head and Neck Surgery, Flinders Medical Centre  Bedford Park South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danny J.","family":"Eckert","sequence":"additional","affiliation":[{"name":"Flinders Health and Medical Research Institute\/Adelaide Institute for Sleep Health Flinders University  Bedford Park South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"e_1_2_10_2_1","article-title":"The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications (Version 2.0)","author":"Berry R. B.","year":"2012","journal-title":"American Academy of Sleep Medicine"},{"issue":"6","key":"e_1_2_10_3_1","doi-asserted-by":"crossref","first-page":"1801","DOI":"10.1097\/SCS.0b013e3181f40551","article-title":"What Is the Efficacy of Nasal Surgery in Patients With Obstructive Sleep Apnea Syndrome?","volume":"21","author":"Bican A.","year":"2010","journal-title":"Journal of Craniofacial Surgery"},{"issue":"6","key":"e_1_2_10_4_1","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1152\/japplphysiol.00588.2025","article-title":"Differential Genioglossus Muscle Responses to Changes in Breathing Route in Awake People With and Without Obstructive Sleep Apnea","volume":"140","author":"Burke P. G. R.","year":"2026","journal-title":"Journal of Applied Physiology"},{"issue":"6","key":"e_1_2_10_5_1","doi-asserted-by":"crossref","first-page":"2723","DOI":"10.1007\/s11845-021-02896-6","article-title":"Surgical Correction of Nasal Obstruction in Obstructive Sleep Apnea Improves CPAP Outcomes and Compliance","volume":"191","author":"Elwany S.","year":"2022","journal-title":"Irish Journal of Medical Science"},{"issue":"1","key":"e_1_2_10_6_1","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/j.chest.2023.01.027","article-title":"Single\u2010Night Diagnosis of Sleep Apnea Contributes to Inconsistent Cardiovascular Outcome Findings","volume":"164","author":"Lechat B.","year":"2023","journal-title":"Chest"},{"issue":"6","key":"e_1_2_10_7_1","doi-asserted-by":"crossref","first-page":"907","DOI":"10.5664\/jcsm.7848","article-title":"The Effect of Upper Airway Surgery on Loop Gain in Obstructive Sleep Apnea","volume":"15","author":"Li Y.","year":"2019","journal-title":"Journal of Clinical Sleep Medicine"},{"issue":"14","key":"e_1_2_10_8_1","doi-asserted-by":"crossref","first-page":"3971","DOI":"10.3390\/jcm11143971","article-title":"Correlations of Obstructive Sleep Apnea Syndrome and Daytime Sleepiness With the Risk of Car Accidents in Adult Working Population: A Systematic Review and Meta\u2010Analysis With a Gender\u2010Based Approach","volume":"11","author":"Luzzi V.","year":"2022","journal-title":"Journal of Clinical Medicine"},{"issue":"12","key":"e_1_2_10_9_1","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1001\/jama.2020.14265","article-title":"Effect of Multilevel Upper Airway Surgery vs Medical Management on the Apnea\u2010Hypopnea Index and Patient\u2010Reported Daytime Sleepiness Among Patients With Moderate or Severe Obstructive Sleep Apnea: The SAMS Randomized Clinical Trial","volume":"324","author":"MacKay S.","year":"2020","journal-title":"Journal of the American Medical Association"},{"issue":"1","key":"e_1_2_10_10_1","doi-asserted-by":"crossref","first-page":"1474","DOI":"10.1080\/13696998.2026.2671550","article-title":"CPAP Treatment Persistence Following Nasal Procedures in Obstructive Sleep Apnea: A Real\u2010World Claims\u2010Based Analysis of 1.3 Million Patients","volume":"29","author":"Malhotra A.","year":"2026","journal-title":"Journal of Medical Economics"},{"issue":"1","key":"e_1_2_10_11_1","doi-asserted-by":"crossref","first-page":"59","DOI":"10.2500\/ajr.2008.22.3120","article-title":"Effects of Nasal Surgery on Sleep Quality in Obstructive Sleep Apnea Syndrome With Nasal Obstruction","volume":"22","author":"Nakata S.","year":"2008","journal-title":"American Journal of Rhinology"},{"issue":"7","key":"e_1_2_10_12_1","doi-asserted-by":"crossref","first-page":"zsz080","DOI":"10.1093\/sleep\/zsz080","article-title":"Upper Airway Collapsibility Measured Using a Simple Wakefulness Test Closely Relates to the Pharyngeal Critical Closing Pressure During Sleep in Obstructive Sleep Apnea","volume":"42","author":"Osman A. M.","year":"2019","journal-title":"Sleep"},{"key":"e_1_2_10_13_1","doi-asserted-by":"crossref","first-page":"21","DOI":"10.2147\/NSS.S124657","article-title":"Obstructive Sleep Apnea: Current Perspectives","volume":"10","author":"Osman A. M.","year":"2018","journal-title":"Nature and Science of Sleep"},{"issue":"6","key":"e_1_2_10_14_1","doi-asserted-by":"crossref","first-page":"e98765","DOI":"10.1371\/journal.pone.0098765","article-title":"Clinical Effect of Surgical Correction for Nasal Pathology on the Treatment of Obstructive Sleep Apnea Syndrome","volume":"9","author":"Park C. Y.","year":"2014","journal-title":"PLoS One"},{"issue":"9","key":"e_1_2_10_15_1","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1164\/rccm.201707-1435OC","article-title":"Phenotyping Pharyngeal Pathophysiology Using Polysomnography in Patients With Obstructive Sleep Apnea","volume":"197","author":"Sands S. A.","year":"2018","journal-title":"American Journal of Respiratory and Critical Care Medicine"},{"issue":"3","key":"e_1_2_10_16_1","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1164\/ajrccm\/145.3.527","article-title":"Effect of Uvulopalatopharyngoplasty on Upper Airway Collapsibility in Obstructive Sleep Apnea","volume":"145","author":"Schwartz A. R.","year":"1992","journal-title":"American Review of Respiratory Disease"},{"key":"e_1_2_10_17_1","doi-asserted-by":"crossref","first-page":"1562","DOI":"10.1164\/rccm.202507-1574ST","article-title":"Research Priorities for Translating Endophenotyping of Adult Obstructive Sleep Apnea to the Clinic. An Official American Thoracic Society Research Statement","volume":"211","author":"Tolbert T. M.","year":"2025","journal-title":"American Journal of Respiratory and Critical Care Medicine"},{"issue":"11","key":"e_1_2_10_18_1","doi-asserted-by":"crossref","first-page":"2606","DOI":"10.1002\/lary.23584","article-title":"Effects of Nasal Surgery on the Upper Airway: A Drug\u2010Induced Sleep Endoscopy Study","volume":"122","author":"Victores A. J.","year":"2012","journal-title":"Laryngoscope"},{"issue":"5","key":"e_1_2_10_19_1","doi-asserted-by":"crossref","first-page":"zsaf012","DOI":"10.1093\/sleep\/zsaf012","article-title":"Polysomnographic Endotypes of Successful Multilevel Upper Airway Surgery for Obstructive Sleep Apnea","volume":"48","author":"Wang X.","year":"2025","journal-title":"Sleep"},{"issue":"2","key":"e_1_2_10_20_1","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1513\/pats.200708-119MG","article-title":"Adherence to Continuous Positive Airway Pressure Therapy: The Challenge to Effective Treatment","volume":"5","author":"Weaver T. E.","year":"2008","journal-title":"Proceedings of the American Thoracic Society"},{"issue":"5","key":"e_1_2_10_21_1","doi-asserted-by":"crossref","first-page":"e6008","DOI":"10.1097\/MD.0000000000006008","article-title":"Apnea\u2010Hypopnea Index Decreased Significantly After Nasal Surgery for Obstructive Sleep Apnea: A Meta\u2010Analysis","volume":"96","author":"Wu J.","year":"2017","journal-title":"Medicine"},{"issue":"2","key":"e_1_2_10_22_1","first-page":"158","article-title":"Disturbed Sleep and Prolonged Apnea During Nasal Obstruction in Normal Men","volume":"124","author":"Zwillich C. W.","year":"1981","journal-title":"American Review of Respiratory Disease"}],"container-title":["Journal of Sleep Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jsr.70416","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jsr.70416","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jsr.70416","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T10:48:48Z","timestamp":1786618128000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jsr.70416"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,13]]},"references-count":21,"alternative-id":["10.1111\/jsr.70416"],"URL":"https:\/\/doi.org\/10.1111\/jsr.70416","archive":["Portico"],"relation":{},"ISSN":["0962-1105","1365-2869"],"issn-type":[{"value":"0962-1105","type":"print"},{"value":"1365-2869","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,13]]},"assertion":[{"value":"2025-09-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70416"}}