The effects of nasal dilation on snoring and obstructive sleep apnea

Characteristics of nasal airflow and the effect of a nasal dilator in normal human subjects

Nasal resistance contributes to negative airway pressure during breathing. We sought to define normal patterns of nasal flow and the effects of mechanical dilatation and splinting of the nares on flow during forced inspiration and expiration. Maximal inspiratory and expiratory flow volume loops (FVL) were determined in 17 normal subjects. Oral FVL were obtained with nares clamped and nasal FVL through a mask with and without dilatation of nares using a plastic splint (Nozovent). Oral FVL were normal in all. Two patterns of nasal FVL were observed: one indicating 'variable' extrathoracic obstruction, the other indicating 'fixed' extrathoracic obstruction. Maximal inspiratory flow at 50% of vital capacity (FiF50) was improved by the Nozovent only in those with a 'variable' pattern (FIF50 (L/sec): 1.54 +/- 0.3 to 2.86 +/- 0.5; P < 0.05, versus 1.92 +/- 0.3 to 2.21 +/- 0.3: P = 0.5). In subjects with a fixed pattern, failure of dilatation of the nares to increase flow suggests that the site of inspiratory flow limitation is within the bony nostril.

Effects of different mechanical treatments on nasal resistance assessed by rhinometry

The goal of this study was to compare the effectiveness of three treatments aiming to reduce nasal airflow resistance (NR): an external nasal strip device (Respir+), an internal nasal mechanical dilator (Nozovent), and a topical decongestant (Pernazène). NR was estimated by active posterior rhinometry at both a 0.5 L/s flow (NRF) and a 1 cm H2O pressure (NRP), under four conditions: in the basal state, with Respir+, with Nozovent, and after treatment with Pernazène. The efficacy of each treatment was assessed by the percentage changes in NRF and NRP (%NRF and %NRP, respectively). The study was performed in 15 healthy subjects. The efficacy of the treatments was significantly different, depending on whether it was evaluated by NRF or by NRP (p<0.02), with %NRF and %NRP values, respectively, equal to the following: 88+/-20% and 91+/-14% with Respir+, 58+/-17% and 70+/-13% with Nozovent, and 55+/-29% and 69+/-22% with Pernazène. NRF remained unchanged with Respir+, whereas it significantly decreased with Nozovent and Pernazène (p<0.0001). No significant difference was observed between the effects of the two latter treatments. These results demonstrate that Nozovent, which involves no risk of side effects or drug interactions, is an effective treatment to improve nasal breathing. Nozovent might therefore be recommended as an alternative to topical decongestants, for certain subjects presenting with nasal obstruction.

Role of the external nasal dilator in the management of nasal obstruction

The aim of this study is to evaluate the effect of an external nasal dilator in patients with nasal obstruction secondary to mucosal congestion (n = 33) or to septal deviation in the nasal valve area (n = 28). A group of subjects with healthy nasal cavities was tested also (n = 51). Acoustic rhinometric and rhinomanometric nasal measurements were performed with and without the dilator and before and after topical decongestion of the nasal mucosa. A visual analog scale was employed to evaluate the subjective sensation of nasal obstruction. Objective measurements showed that the external dilator increased the minimum cross-sectional area and decreased the nasal resistance significantly in all three groups (P < 0.01). The effect was more impressive in patients with septal deviation (P < 0.001). Subjective assessments reflected patency in all subjects except those in the mucosal swelling group (P = 0.06). From this study the authors conclude that the external nasal dilator offers an effective, nonsurgical therapeutic approach in the management of septal deviation that obstructs the nasal valve area. Although patients with nasal obstruction secondary to mucosal congestion showed objective improvement with the nasal dilator, these changes were not accompanied by a sensation of enhanced patency.

Change in minimal cross sectional area using the new nasal dilator, "Airplus"

In 36 persons without nasal complaints nasal cavities were investigated using acoustic rhinometry (Rhin 2000), to study the effect of a nasal dilator (ND) named "Airplus". The minimal cross sectional area (MCA) of both the right and left side was assessed before and after application of the ND, and the total MCA was calculated as the sum of the right and left side. In 8 persons the MCA was measured before and after 2 applications of the ND. In 8 persons the MCA was measured before, immediately after and 2 hours after application of the ND. In trial one the median total MCA was 1.37 cm2 before and 1.96 cm2 after application of the ND. This corresponds to an increase of 43%, p < 0.000-01. In trial two the median total MCA was increased from 1.37 cm2 respectively 1.35 cm2 to 1.98 cm2 respectively 2.01 cm3, an increase of 45% respectively 49%, p < 0.008 in both. In trial three the median total MCA was 1.21 cm2 before and 1.95 cm2 immediately after application and 1.93 cm2 after 2 hours. The increase was 61 and 59%, p < 0.008 in both. The results show that the "Airplus" nasal dilator improves significantly the MCA, it was possible to reproduce the effect and it was stable in the recorded period.

Excessive daytime sleepiness at work and subjective work performance in the general population and among heavy snorers and patients with obstructive sleep apnea

STUDY OBJECTIVE

To evaluate excessive daytime sleepiness (EDS) at work and effects on reported work performance among men in the general population and male patients suffering from snoring and obstructive sleep apnea syndrome (OSAS).

DESIGN AND PARTICIPANTS

A cross-sectional study of Swedish men between the ages of 30 and 64 years in the county of Kopparberg, in mid-Sweden. A random sample of the general population (n = 285) and consecutive patients referred to a sleep laboratory who fulfilled objective diagnostic criteria (snorers = 289, OSAS = 62) responded to a questionnaire. Responders from the general population were divided into 2 groups, nonsnorers (n = 223) and snorers (n = 62). To validate a question on snoring in the questionnaire, 50 men, randomly selected from the sample of the general population, underwent sleep apnea screening in their homes.

RESULTS

The specificity of the questions about snoring was 83% and the sensitivity was 42%. The risk ratios for reporting EDS at work were 4-fold for snorers in the general population, 20-fold for snoring patients, and 40-fold for patients with OSAS as compared with nonsnoring men in the general population. Patients with OSAS and snoring patients both showed increased ratios on measures of difficulties with concentration, learning new tasks, and performing monotonous tasks when compared with nonsnorers.

CONCLUSION

Snoring and sleep apnea were highly associated with excessive EDS at work and subjective work performance problems. The results provide additional evidence that snoring is not merely a nuisance.

Headache, snoring and sleep apnoea

To evaluate reported headache prevalence among the general population and patients suffering from snoring and obstructive sleep apnoea syndrome (OSAS), a cross-sectional study was performed among those aged 30-64 years residing in Kopparberg county in central Sweden. Consecutive patients referred to the sleep laboratory in the catchment area who fulfilled objective diagnostic criteria (snorers = 448, OSAS = 324) and a random sample of the general population (n = 583) responded to the same questionnaire. Patients were selected following sleep apnoea screening with 100% specificity for both OSAS and snoring. Responders from the general population were divided into snorers or non-snorers on the basis of self-report. To validate the self-report question on snoring in the questionnaire, 50 males and 49 females, randomly selected from the sample of the general population, underwent sleep apnoea screening in their homes. Headache among both men and women was found to be more prevalent among heavy snorers and OSAS patients compared with the control group. Morning headache, in particular, was at least three times more common among male and female heavy snorers and OSAS patients then among the general population. Headache in the control group was more common among snorers than non-snorers. Among responders, 5% of the general population reported experiencing headache often or very often upon awakening. For the heavy snoring and OSAS groups, 18% reported experiencing headache often or very often upon awakening. The results indicate that headache is common among heavy snorers and OSAS patients regardless of gender.

Multifactorial obstructive sleep apnea in a patient with Chiari malformation

We report a patient with severe obstructive sleep apnea (OSA) associated with a unique combination of syringobulbia-myelia, Chiari malformation type I (CM), absent hypoxic ventilatory drive, vocal cord paralysis, post-menopausal status, obesity, and acute respiratory failure necessitating mechanical ventilation. The remote onset of OSA five years after surgery underscores the need for long-term follow-up of patients with syringobulbia-myelia and CM and the importance of addressing multiple interacting neurologic, metabolic, and mechanical predispositions to sleep-disordered breathing.