الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Snoring and/or Obstructive sleep apnea (OSA), are worldwide common chronic disorders that that affects virtually every organ system and are associated with impaired quality of life and increased risk of morbidities and mortality.
Many factors contribute to snoring and OSA at the same time. Differing levels of obstruction, and personal characteristics (BMI and age), play an important role in defining the line of treatment.
Published data suggested that when nasal obstruction is identified in cases of OSA with suspected oropharyngeal and nasal obstruction, the combination of nasal and palate surgeries should be conducted in either a single-staged or multi staged manner.
Outcomes of a staged or a single-stage multilevel surgery remain a matter of discussion, it is unclear whether oropharyngeal and nasal surgery should be performed simultaneously or separately because research addressing this issue is scarce.
The aim of this study was to assess safety, efficacy, and surgical success of the combined nasal-palatopharyngeal surgery when performed in a staged versus a single-stage multilevel procedure.
This study was conducted in the Otorhinolaryngology-Head & Neck Surgery Department, at the Alexandria Main University Hospital. To fulfill the objectives of this study a prospective randomized comparative approach was adopted.
Target population was confined to 60 patients with combined nasal and retropalatal obstruction, >18 years old, BMI<40, with snoring and/or mild to moderate OSA (AHI ˂30) and ASA<3. Patients who needed a tongue base surgery were not included in the study. Patients were randomly allocated into three groups. group 1 patients (n=20) underwent nasal surgery as a first step for management of their nasal obstruction, followed by a BRP after three months. group 2 patients (n=20) underwent a BRP as a first step, then followed by a nasal surgery after three months, and group 3; patients (n=20) had a single stage multilevel surgery, where combined nasal and palate (BRP) surgeries were done at the same sitting.