Dear Editor,Most studies of the pathophysiology of obstructive sleep apnea syndrome (OSA) have emphasized anatomical abnormalities of the oropharyngeal and hypopharyngeal airways. Yet the nose and its impact on snoring and OSAS have not been completely ignored.Dr. Neto and his friends emphasized that, structural alterations of the nasal cavity have high incidence in patients with OSA. These structural alterations such as septal deviation, conchal hypertrophy or others lead to obstruction of natural air flow and consequently increased nasal resistance.Some studies reported that, nasal resistance has no impact on the pathogenesis of OSA. Thus, both snoring and sleep apnea are probably caused by other factors, such as restrictive processes in the pharyngeal area, rather than increased nasal resistance2, 3, 4.Metes et al. did not find any effect on snoring, apneas, hypopneas or oxygen saturation in a small sample of patients, despite a reduction in nasal resistance.Nasal surgery for OSA usually has a very positive effect on improving the quality of life and CPAP tolerance in OSA patients3, 5.