Conclusion Nasal obstruction can aggravate the psychological status of OSA patients, and nasal surgery should reduce this aggravation. Nasal surgery significantly improved sleep latency and ameliorated several polysomnographic characteristics.Background The aim of this study was to investigate the psychological status of patients with obstructive sleep apnea (OSA) and nasal obstruction and to evaluate the effects of nasal surgery on the psychological symptoms and polysomnographic (PSG) parameters of these patients.Methods The study was designed as a prospective comparative study. This study compared 30 patients (all male) with nasal obstruction and 30 matched patients without nasal obstruction using the Pittsburgh Sleep Quality Index (PSQI) and the Symptom Check List 90 (SCL-90). All of the patients had been previously diagnosed with OSA (apnea hypopnea index [AHI] 5 events/h) via a whole-night polysomnographic examination. Nasal obstruction was assessed using a visual analogue scale (VAS). The patients with nasal obstruction underwent nasal surgery, and their weight, VAS, nocturnal PSG characteristics, and psychological symptoms at baseline and 3 months after surgery were compared.Results The OSA patients with nasal obstruction suffered from significantly longer sleep latency on the PSQI and higher somatization and anxiety scores on the SCL-90 than the subjects without nasal obstruction (p<0.05). The nasal obstruction symptoms significantly improved after surgery (VAS decreased from 6.18 +/- 1.85 to 1.87 +/- 1.76, p<0.01). The assessments also showed a significant reduction in weight (from 84.60 +/- 11.30kg to 82.27 +/- 9.87kg, p<0.05) between the pre-operative and post-operative values. Although there was significant reduction in the AHI (from 49.67 +/- 19.49/h to 43.07 +/- 21.86/h, p<0.01) and a significant improvement in lowest oxygen saturation (LSpO(2), from 73.83 +/- 8.49% to 75.97 +/- 9.86%, p<0.05), only 23.3% of patients achieved a response of nasal surgery that met Sher's criteria. Remarkable reductions were observed in the sleep latency scores, daytime dysfunction scores on the PSQI, anxiety and hostility scores, and the number of positive symptoms on the SCL-90 (p<0.05). There was a strong positive correlation between PSQI total score and some psychosomatic symptoms on the SCL-90, including inter-personal sensitivity, depression, hostility, paranoid ideation, psychoticism, global symptom index, and the number of positive symptoms (r>0.3, p<0.05).