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Erickson TS, Durr ML. Sex Differences in Obstructive Sleep Apnea Including Pregnancy and Response to Treatment. Otolaryngol Clin North Am 2024; 57:467-480. [PMID: 38485541 DOI: 10.1016/j.otc.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2024]
Abstract
This article highlights the sex differences in obstructive sleep apnea (OSA) and sheds light on the varying presentations, diagnostic challenges, as well as treatment responses observed in men and women. The disparities in prevalence, manifestations, and therapeutic outcomes underscore the need for a nuanced approach to OSA diagnosis and management that considers sex-specific factors. Furthermore, this article highlights the importance of recognizing and treating OSA during pregnancy, as it poses unique challenges and potential risks to both maternal and fetal health.
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Affiliation(s)
- Taylor S Erickson
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, 2233 Post Street, San Francisco, CA 94115, USA
| | - Megan L Durr
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, 1001 Potrero Avenue, #3A30, San Francisco, CA 94110, USA.
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Grajczyk A, Sobczyk K, Zarzecka J, Barcz E, Dżaman K. Objective Measurements of Nasal Obstruction and Eustachian Tube Function in Pregnant Women. J Clin Med 2024; 13:2671. [PMID: 38731199 PMCID: PMC11084222 DOI: 10.3390/jcm13092671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/25/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Hormonal changes during pregnancy have a substantial effect on the swelling of the mucous membrane in the nasal cavity, resulting in rhinitis and Eustachian tube dysfunction. The aim of the study was to assess subjective and objective changes in nasal cavity and Eustachian tube patency in the third trimester of pregnancy. Materials and Methods: The study group included fifty 18-41 year-old women in the third trimester of pregnancy. The control group consisted of 25 females aged 25 to 31 who were not pregnant. The Eustachian tube and nasal cavity patency examination was carried out using a rhinomanometer, a tympanometer and a SNOT-22 Questionnaire. Results: The SNOT-22 showed that subjective nasal obstruction was assessed as strong or worse by 42% of the study group, which was significantly higher than in the control group and confirmed with rhinomanometry. A total of 68% of the study group reported a subjective ear fullness which correlated with the week of pregnancy. The tympanometry showed that all pregnant women exhibited a type A tympanogram, but tympanometry values decreased at higher weeks of pregnancy, and statistical analysis confirmed a significant difference between the study group and the control group in tympanometry for both ears. Conclusions: The results highlight the substantial impact on both subjective and objective measurements of nasal and Eustachian tube patency. Almost every woman in the third trimester of pregnancy experiences nasal obstruction, and nearly 70% struggle with ear fullness. Recognizing and addressing these challenges are pivotal for ensuring the well-being of pregnant individuals and enhancing the quality of antenatal care.
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Affiliation(s)
- Alicja Grajczyk
- Department of Otolaryngology, Collegium Medicum, Faculty of Medicine, Cardinal Stefan Wyszyński University, Międzylesie Specialist Hospital, 01-938 Warsaw, Poland;
| | - Krystyna Sobczyk
- Department of Otolaryngology, Centre of Postgraduate Medical Education, Marymoncka 99/103, 01-813 Warsaw, Poland;
| | - Justyna Zarzecka
- Department of Gynecology and Obsetrics, Collegium Medicum, Faculty of Medicine, Cardinal Stefan Wyszyński University, Międzylesie Specialist Hospital, 01-938 Warsaw, Poland; (J.Z.); (E.B.)
| | - Ewa Barcz
- Department of Gynecology and Obsetrics, Collegium Medicum, Faculty of Medicine, Cardinal Stefan Wyszyński University, Międzylesie Specialist Hospital, 01-938 Warsaw, Poland; (J.Z.); (E.B.)
| | - Karolina Dżaman
- Department of Otolaryngology, Centre of Postgraduate Medical Education, Marymoncka 99/103, 01-813 Warsaw, Poland;
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Al-Ani RM, Alaqeedy AA, Rashid RA. Prevalence and risk factors of the pregnancy rhinitis at Tikrit General Hospital, Tikrit City, Iraq. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2022. [DOI: 10.1186/s43163-022-00344-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Abstract
Background
Pregnancy rhinitis (PR) is a relatively common condition with a prevalence of 20%. We aimed to identify the prevalence and risk factors of the PR. A prospective cohort study was conducted at the Obstetric and Gyenocology and Otolaryngology Departments in the Tikrit General Hospital, Tikrit City, Iraq. The study covered 12 months (September 2019–September 2020). Pregnant women were divided into two groups; with and without PR. Data regarding the age, body mass index (BMI), occupation, smoking, clinical features, parity, gestational age, and sex of the baby were recorded. Visual analog scale (VAS) and nasal-obstructive-symptom-evaluation (NOSE) scale were used for the evaluation of the nasal obstruction.
Results
The prevalence of the PR was 11.65% (110/944 pregnant women). Rhinorrhea was the commonest associated feature with nasal obstruction of the PR (n = 48, 43.6%). Ninety percent of the patients were in the age group < 35 years. The majority of the subjects were housewives (n = 551, 58.4%), in the second trimester (n = 456, 48.3%), and in the parity group 0–2 (n = 511, 54.1%). The female baby was found in 56.5% of the patients (n = 533). There were statistically significant differences between the two groups: women with and without PR regarding the BMI and gestational age (first trimester) (P value = 0.001). No history of current smoking was found in all women.
Conclusion
The prevalence of PR was 11.65% and was mostly seen in the first trimester. High BMI and pregnant women in the first trimester were considered risk factors for the PR.
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Saito J, Yakuwa N, Sasaki A, Kawasaki H, Suzuki T, Yamatani A, Sago H, Murashima A. Emedastine During Pregnancy and Lactation: Emedastine Levels in Maternal Serum, Cord Blood, Breast Milk, and Neonatal Serum. Breastfeed Med 2020; 15:809-812. [PMID: 33035080 DOI: 10.1089/bfm.2020.0249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Emedastine difumarate is a second-generation antihistamine that is more effective for nasal congestion than first-generation antihistamines. The oral form of emedastine is used for the treatment of allergic rhinitis (AR). However, data characterizing emedastine transfer across the placenta and excretion into breast milk are limited. In this case report, we assessed emedastine concentrations in maternal and neonatal blood, cord blood, and breast milk. Materials and Methods: After the patient provided informed consent, emedastine concentrations in maternal serum, breast milk, cord blood, and neonatal serum were measured while the mother was taking oral emedastine 2 mg once daily. Case Report: A 39-year-old woman with AR received emedastine during pregnancy and lactation. Her female infant was born at 37 weeks of gestation with a birth weight of 2,820 g. Emedastine concentrations in maternal serum at 11.5 and 19.0 hours after maternal dosing were 0.39 and 0.22 ng/mL, respectively. The emedastine concentration in cord blood (19.6 hours after maternal dosing) was 0.18 ng/mL. At 24 hours after delivery (44 hours after maternal dosing), emedastine was under the lower limit of quantification (<0.05 ng/mL) in the infant's serum. Emedastine concentrations in breast milk ranged from 0.06 to 0.44 ng/mL. Calculated infant doses through breast milk were much lower than the clinical dose of emedastine. The infant had normal developmental progress and no detectable drug-related adverse effects. Conclusions: Rates of emedastine transfer into placenta and breast milk were low. Further study is required to assess the safety of emedastine in fetuses and breastfed infants.
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Affiliation(s)
- Jumpei Saito
- Department of Pharmaceuticals, National Center for Child Health and Development, Tokyo, Japan
| | - Naho Yakuwa
- Japan Drug Information Institute in Pregnancy, National Center for Child Health and Development, Tokyo, Japan
| | - Aiko Sasaki
- Division of Obstetrics, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Hiroyo Kawasaki
- Department of Pharmaceuticals, National Center for Child Health and Development, Tokyo, Japan
| | - Tomo Suzuki
- Division of Obstetrics, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Akimasa Yamatani
- Department of Pharmaceuticals, National Center for Child Health and Development, Tokyo, Japan
| | - Haruhiko Sago
- Division of Obstetrics, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Atsuko Murashima
- Japan Drug Information Institute in Pregnancy, National Center for Child Health and Development, Tokyo, Japan.,Division of Maternal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
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Abstract
Approximately 90% of pregnant women use medications while they are pregnant including both over-the-counter (OTC) and prescription medications. Some medications can pose a threat to the pregnant woman and fetus with 10% of all birth defects directly linked to medications taken during pregnancy. Many medications have documented safety for use during pregnancy, but research is limited due to ethical concerns of exposing the fetus to potential risks. Much of the information gleaned about safety in pregnancy is collected from registries, case studies and reports, animal studies, and outcomes management of pregnant women. Common OTC categories of readily accessible medications include antipyretics, analgesics, nonsteroidal anti-inflammatory drugs, nasal topicals, antihistamines, decongestants, expectorants, antacids, antidiarrheal, and topical dermatological medications. We review the safety categories for medications related to pregnancy and provide an overview of OTC medications a pregnant woman may consider for management of common conditions.
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Fornazieri MA, Prina DMC, Favoreto JPM, Rodrigues e Silva K, Ueda DM, de Rezende Pinna F, Voegels RL, Cameron L, Doty RL. Olfaction During Pregnancy and Postpartum Period. CHEMOSENS PERCEPT 2019. [DOI: 10.1007/s12078-019-09259-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ulkumen B, Ulkumen BA, Pala HG, Celik O, Sahin N, Karaca G, Demirdag M. Pregnancy rhinitis in Turkish women: Do gestational week, BMI and parity affect nasal congestion? Pak J Med Sci 2016; 32:950-4. [PMID: 27648046 PMCID: PMC5017109 DOI: 10.12669/pjms.324.10164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To determine the cumulative incidence of pregnancy rhinitis along with prevalence in different trimesters and to find out whether gestational age, BMI and parity have any effect on pregnancy related nasal congestion. Methods: In the prospective protocol at the obstetrics outpatient clinic, 167 pregnant women were enrolled consecutively. According to exclusion criteria, 67 of them were excluded. Visual-Analogue-Scale (VAS), Nasal-Obstructive-Symptom-Evaluation (NOSE) scale and Discharge-Inflammation-Polyps/Oedema (DIP) scoring were utilized for diagnosis of pregnancy rhinitis. Besides, weight, length, age, parity and week of pregnancy were recorded. Results: Total prevalence of pregnancy rhinitis was 17.17% and cumulative incidence was 38.89%. Our study revealed significant relation of NOSE score with both gestational week (r=0.474, p=0.001) and BMI (r=0.301, p=0.003). VAS score was significantly related with gestational week (r=0.409, p=0.001) and BMI (r=0.270, p=0.007). DIP score was found to be correlated only with gestational week (r=0.375, p=0.001). Conclusion: Cumulative incidence of pregnancy rhinitis was 38.89%. Nasal congestion was significantly associated with BMI and gestational week. Patients should be informed about unfavorable fetal and maternal outcomes of pregnancy related nasal congestion which is triggered by obesity and excessive weight gain in pregnancy.
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Affiliation(s)
- Burak Ulkumen
- Burak Ulkumen, Assistant Professor, Department of Otorhinolaryngology, Celal Bayar University, School of Medicine, Manisa, Turkey
| | - Burcu Artunc Ulkumen
- Burcu Artunc Ulkumen, Associate Professor, Department of Obstetrics and Gynecology, Celal Bayar University, School of Medicine, Manisa, Turkey
| | - Halil Gursoy Pala
- Dr. Halil Gursoy Pala, Department of Obstetrics and Gynecology, Celal Bayar University, School of Medicine, Manisa, Turkey
| | - Onur Celik
- Prof. Onur Celik, Professor, Department of Otorhinolaryngology, Celal Bayar University, School of Medicine, Manisa, Turkey
| | - Nevin Sahin
- Dr. Nevin Sahin, Department of Otorhinolaryngology, Celal Bayar University, School of Medicine, Manisa, Turkey
| | - Gizem Karaca
- Dr. Gizem Karaca, Department of Otorhinolaryngology, Celal Bayar University, School of Medicine, Manisa, Turkey
| | - Meltem Demirdag
- Dr. Meltem Demirdag, Department of Otorhinolaryngology, Celal Bayar University, School of Medicine, Manisa, Turkey
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Namazy JA, Schatz M. The safety of intranasal steroids during pregnancy: A good start. J Allergy Clin Immunol 2016; 138:105-6. [DOI: 10.1016/j.jaci.2016.04.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 04/20/2016] [Indexed: 12/29/2022]
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Caparroz FA, Gregorio LL, Bongiovanni G, Izu SC, Kosugi EM. Rhinitis and pregnancy: literature review. Braz J Otorhinolaryngol 2016; 82:105-11. [PMID: 26601995 PMCID: PMC9444647 DOI: 10.1016/j.bjorl.2015.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 04/23/2015] [Indexed: 12/03/2022] Open
Abstract
Introduction There is a controversy concerning the terminology and definition of rhinitis in pregnancy. Gestational rhinitis is a relatively common condition, which has drawn increasing interest in recent years due to a possible association with maternal obstructive sleep apnea syndrome (OSAS) and unfavorable fetal outcomes. Objective To review the current knowledge on gestacional rhinitis, and to assess its evidence. Methods Structured literature search. Results Gestational rhinitis and rhinitis “during pregnancy” are somewhat similar conditions regarding their physiopathology and treatment, but differ regarding definition and prognosis. Hormonal changes have a presumed etiological role, but knowledge about the physiopathology of gestational rhinitis is still lacking. Management of rhinitis during pregnancy focuses on the minimal intervention required for symptom relief. Conclusion As it has a great impact on maternal quality of life, both the otorhinolaryngologist and the obstetrician must be careful concerning the early diagnosis and treatment of gestational rhinitis, considering the safety of treatment measures and drugs and their current level of evidence.
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Powell H, Murphy VE, Hensley MJ, Giles W, Clifton VL, Gibson PG. Rhinitis in pregnant women with asthma is associated with poorer asthma control and quality of life. J Asthma 2015; 52:1023-30. [PMID: 26365758 DOI: 10.3109/02770903.2015.1054403] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To describe the pattern and severity of rhinitis in pregnancy and the impact rhinitis has on asthma control and quality of life (QoL) in pregnant women with asthma. METHODS Two hundred and eighteen non-smoking pregnant women with asthma were participants in a randomised controlled trial of exhaled nitric oxide guided treatment adjustment. Rhinitis was assessed using a visual analogue scale (VAS) scored from 0 to 10 and classified as current (VAS > 2.5), moderate/severe versus mild (VAS > 6 vs <5), atopic versus non-atopic and pregnancy rhinitis. At baseline, women completed the 20-Item Sino-Nasal Outcome Test (SNOT20), asthma-specific (AQLQ-M) QoL questionnaires and the Six-Item Short-Form State Trait Anxiety Inventory (STAI-6). Asthma control was assessed using the asthma control questionnaire (ACQ). Perinatal outcomes were collected after delivery. RESULTS Current rhinitis was present in 142 (65%) women including 45 (20%) women who developed pregnancy rhinitis. Women with current rhinitis had higher scores for ACQ (p = 0.004), SNOT20 (p < 0.0001) and AQLQ-M (p < 0.0001) compared to women with no rhinitis. Current rhinitis was associated with increased anxiety symptoms (p = 0.002), rhinitis severity was associated with higher ACQ score (p = 0.004) and atopic rhinitis was associated with poorer lung function (p = 0.037). Rhinitis symptom severity improved significantly during gestation (p < 0.0001). There was no impact on perinatal outcomes. Improved asthma control was associated with improvement in rhinitis. CONCLUSION Rhinitis in pregnant women with asthma is common and associated with poorer asthma control, sino-nasal and asthma-specific QoL impairment and anxiety. In the context of active asthma management there was significant improvement in rhinitis symptoms and severity as pregnancy progressed.
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Affiliation(s)
- Heather Powell
- a Centre for Asthma and Respiratory Diseases, University of Newcastle and Hunter Medical Research Institute , Newcastle , NSW , Australia .,b Department of Respiratory and Sleep Medicine , John Hunter Hospital , Newcastle , NSW , Australia
| | - Vanessa E Murphy
- a Centre for Asthma and Respiratory Diseases, University of Newcastle and Hunter Medical Research Institute , Newcastle , NSW , Australia
| | - Michael J Hensley
- a Centre for Asthma and Respiratory Diseases, University of Newcastle and Hunter Medical Research Institute , Newcastle , NSW , Australia .,b Department of Respiratory and Sleep Medicine , John Hunter Hospital , Newcastle , NSW , Australia
| | - Warwick Giles
- c Obstetrics, Gynaecology and Neonatal, Northern Clinical School, University of Sydney , Sydney , NSW , Australia .,d Royal North Shore Hospital , Sydney , NSW , Australia , and
| | - Vicki L Clifton
- e Robinson Institute, Department Obstetrics and Gynaecology, University of Adelaide , SA , Australia
| | - Peter G Gibson
- a Centre for Asthma and Respiratory Diseases, University of Newcastle and Hunter Medical Research Institute , Newcastle , NSW , Australia .,b Department of Respiratory and Sleep Medicine , John Hunter Hospital , Newcastle , NSW , Australia
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