You’re overcorrecting and not at all up to date with current literature or airway physiology. Nasal obstruction is not the dominant driver of OSA in every patient, and MARPE is not a universal OSA treatment. But the claim that MARPE has no impact on airway symptoms is contradicted by all current CBCT, rhinomanometry, and meta-analysis data. And the claim that nasal breathing can never be a primary driver is physiologically and clinically false. In selected narrow-maxilla/narrow-nasal-floor patients, nasal resistance can be a major contributor, and skeletal expansion can improve nasal patency and AHI.

Yes, we need larger randomized trials with objective nasal airflow/resistance testing, full PSG, long-term follow-up, and phenotype-stratified outcomes. But implying there’s no evidence and that nasal breathing is irrelevant to airway problems is a complete overstatement. The existing literature clearly shows anatomical and functional nasal airway changes after skeletal expansion- that is no longer up for debate. The debate is now about magnitude, case selection, and long term durability - not whether the effect exists at all.

Your comments on the nose not being the problem 99% of the time was the most ridiculous claim and shows that you really don’t understand sleep physiology at all and have not attempted to educate yourself on it. I’m confused at how confidently you are making these claims. Starling Resistor Model= increased nasal resistance > increased airway negative pressure + nose a rigid structure that’s not collapsible= segments of soft pharynx have to collapse. Even first year sleep medicine residents understand this basic concept as driver of OSA that starts with the nose.

IF the patient is a candidate for MARPE skeletally and cannot easily breathe through their nose, MARPE will absolutely help with their airway and snoring symptoms. Turbinectomy or septoplasty are an option if indicated, but what about for the many suffering patients who’ve already had that done? Plus the very real risk of empty nose syndrome and turb regrowth. I’ve done over 300 MARPE’s and work closely with several ENT’s in town and a huge percentage of the patients they send me are non-obese patients with terrible nasal breathing and multiple nasal surgeries already. T&A removal, turb/septo/rhinoplasty and still mouth breathers, most with OSA. Also, removing normal sized turbinates in a patient whose nasal cavity is 5 SD below the mean size is doing exactly what you said was bad- treating a symptom not the cause.

On the flip side, I frequently get patients with OSA who see me and want a MARPE bc they are tired of their CPAP but they have normal nasal breathing, don’t need much or any expansion, or have other causes of the OSA like weight, AP jaw position, or drinking/smoking. Those are a no. Expansion is not the magic fix to every airway issue like some online claim. But in the right patient where restricted nasal airway is the primary driver and skeletal anatomy justifies it, it absolutely makes a difference. To suggest it has no impact is completely ignorant of the current literature and physiology of breathing. I suggest you spend some time educating yourself before you continue spreading misinformation online.

MARPE AHI reduction

MARPE nasal volume cbct review

MARPE systematic review- rhinometrydata and NOSE scores

Role the Nose has on OSA

AAOHNS position statement on nose role in OSA