Impact of Functional Rhinoplasty on Sleep-Disordered Breathing: A Systematic Review and Meta-Analysis

Introduction: Structural nasal obstruction is an important modifier of sleep-disordered breathing (SDB), but the specific impact of functional rhinoplasty on validated sleep-related outcomes has not been quantitatively synthesized. Objective and Hypothesis: To systematically review and meta-analyze studies of adults with SDB undergoing functional rhinoplasty or septorhinoplasty, testing the hypothesis that surgery yields large improvements in nasal obstruction and modest improvements in sleep-related symptoms. Study Design: PROSPERO-registered systematic review and random-effects meta-analysis conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. Methods: PubMed, Embase and Cochrane Library were searched to September 2025 for studies reporting validated symptom scores before and after functional rhinoplasty or septorhinoplasty in adults with SDB. Standardized mean differences (SMDs) with Hartung-Knapp-adjusted confidence intervals were pooled; risk of bias and publication bias were formally assessed. Results: = 1,192) met inclusion criteria. Surgery was associated with large improvement in nasal obstruction (Nasal Obstruction Symptom Evaluation SMD: -4.99; 95% CI: -9.12 to -0.85), moderate reductions in daytime sleepiness (Epworth Sleepiness Scale SMD: -1.09; 95% CI: -2.33 to 0.15) and global sleep disturbance (Pittsburgh Sleep Quality Index SMD: -0.74; 95% CI: -1.21 to -0.26), and modest gains in functional status (Functional Outcomes of Sleep Questionnaire-10 SMD: 0.41; 95% CI: 0.16-0.65). Heterogeneity was substantial for most outcomes and small-study effects were detected. Conclusion: Functional rhinoplasty and septorhinoplasty appear to improve nasal obstruction and sleep-related patient-reported outcomes in adults with SDB, supporting their role as adjunctive procedures in selected patients. High heterogeneity and predominantly observational data highlight the need for larger, phenotype-driven studies to refine effect estimates and patient selection (PROSPERO registration number: CRD420251168358).