Reduced nasal resistance after simple tonsillectomy in patients with obstructive sleep apnea

Correlation between Subjective Nasal Patency and Nasal Capacity in Young Adults: A Pilot Study with a Prototype Device-A Nasoorospirometer

Background: Nasal airway obstruction (NAO) is characterised by high resistance in the nasal cavity with a collapsible and narrowed upper airway and is an integral part of OSA pathophysiology. The literature demonstrates that the identification of high-risk OSA in the young adult population leads to the prevention of later health consequences. A nasoorospirometer is a prototype device that measures nasal capacity during inspiration. The basis for measurement is a Wheatstone bridge and a thermal anemometer. The parameters are recorded via hot wire anemometry (HTA) with velocity measurements in the airflow field. Therefore, this pilot study aimed to test the feasibility of the device by examining a young adult sample. The secondary aim was to determine whether subjective NAO correlates with nasal capacity and whether NAO corresponds with anthropometric parameters and individual risk of OSA. Methods: A group of 31 participants (mean age 24.9 years) underwent a thorough laryngological examination. The nasoorospirometer was used to measure objective NAO (nasal capacity), the NOSE scale was used to gain subjective NAO evaluation, and the Berlin Questionnaire for the risk of OSA. Results: A correlation analysis confirmed no significant associations between the subjective and objective measures (p > 0.05). Higher BMI and neck circumference are associated with lower NAO and higher nasal patency in the population of young adults (r: 0.32-0.45; p < 0.05). The risk of OSA showed no statistically significant association (p > 0.05). Conclusions: We presented three methods of NAO assessment: subjective participant evaluation, objective nasoosopirometry, and objective laryngological assessment. However, the use of a nasoorospirometer with anthropometric measures in young adults needs to be verified in future studies.

International Consensus Statement on Obstructive Sleep Apnea

BACKGROUND

Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA).

METHODS

Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus.

RESULTS

The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated.

CONCLUSION

This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.

Reduction of postural nasal resistance following oropharyngeal surgery in patients with moderate-severe obstructive sleep apnea

BACKGROUND

Patients with obstructive sleep apnea (OSA) have elevated nasopharyngeal resistances due to increased turbulent airflow. The study aims to investigate the effect of oropharyngeal surgery on nasal resistance in patients with various severity levels of OSA.

METHODOLOGY

Patients with greater or equal to 5 events hourly on the apnea-hypopnea index (AHI) were enrolled. Patients with retropalatal obstruction underwent uvulopalatopharyngoplasty, while patients with concurrent retrolingual obstruction under- went uvulopalatopharyngoplasty (UPPP) plus tongue base suspension. Before surgery and after surgery, subjective outcomes were assessed using a visual analog scale (VAS), and objective outcomes were assessed using overnight polysomnography and rhinomanometry. The limitation of the study was that UPPP instead of expansion sphincter pharyngoplasty was performed in this study.

RESULTS

Sixty-two patients were enrolled, while 30 patients were diagnosed as mild OSA (group Mild) and 32 patients were mo- derate-severe OSA (group MS). The preoperative VAS of nasal obstruction in recumbency during sleep was significantly reduced after surgery in group MS. However, no significant differences between preoperative and postoperative VAS were found in group Mild. The postoperative anterior and posterior total nasal resistances (TNR) in sitting and supine positions were not significantly different from those before surgery in group. In contrast, the postoperative posterior TNR in supine position was 0.292±0.301(Pa/ cm3/s), compared with 0.425±0.343(Pa/cm3/s) preoperatively.

CONCLUSIONS

Oropharyngeal surgery improves nasal obstruction during sleep and lowers the supine TNR measured in poste- rior rhinomanometry in patients with moderate-severe OSA. Oropharyngeal surgery is a possible treatment for postural nasal obstruction in patients with moderate-severe OSA.

The impact of oral appliance therapy with moderate mandibular advancement on obstructive sleep apnea and upper airway volume

Purpose

To find out if a moderate protrusion with a mandibular advancement device (MAD) can significantly increase the upper airway volume and, further, what signs and symptoms of obstructive sleep apnea (OSA) can be improved by this maneuver.

Methods

There were 58 adults diagnosed with OSA who were referred for MAD therapy. The mean apnea-hypopnea index (AHI) was 19.2 (SD 8.6). Five indicators of signs and symptoms of OSA (AHI, oxygen saturation, snoring, daytime sleepiness, and health-related quality of life) were evaluated at the baseline and after 6 months of MAD therapy. Nasal resistance and airway volume and cross-sectional areas with and without the MAD in situ were recorded. Based on AHI reduction, the treatment response was classified as complete, partial, or non-complete. Statistical analyses included the chi-square, t tests, Mann–Whitney U tests, and regression analyses (linear and logistic).

Results

Twenty-three patients attained a complete response (residual AHI < 5 events/h) to MAD therapy. In 13 subjects, the response was partial, and in 9 patients, it was non-complete. The complete responders were significantly younger, and they had a deeper overbite than partial/non-complete responders. A convex profile associated positively, but a vertically restricted throat and increased lower facial height associated negatively with the increase in airway volume.

Conclusions

Excellent MAD therapy outcomes were achieved in most patients. Only age and deep bite had some influence on AHI reduction, indicating multifactorial nature in the response to MAD therapy.

The effect of continuous positive airway pressure therapy on nasal patency

BACKGROUND

Nasal congestion and obstruction are reported in the majority of continuous positive airway pressure (CPAP) users and are frequently cited as reasons for noncompliance. To our knowledge, no study has demonstrated a change in objective or subjective nasal patency in patients with obstructive sleep apnea (OSA) after a therapeutic trial of CPAP therapy.

METHODS

This prospective nonrandomized trial tested the hypothesis that CPAP therapy would result in both objective and subjective improvements in nasal patency in patients with OSA. Prior to initiation of CPAP, acoustic rhinometry (AR) was used to determine nasal volume and minimum cross-sectional area in the upright and reclined positions. Subjective nasal patency was assessed with the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire. Both assessments were repeated at follow-up visits.

RESULTS

AR data demonstrated a statistically significant increase in total nasal volume (TV) in the reclined position (p = 0.002) and minimum cross-sectional area (MCA) in both the sitting and reclined positions (p = 0.006, p = 0.021) in OSA patients after >30 days of CPAP therapy and with >70% compliance. NOSE scores decreased significantly (p = 0.038) representing an improvement in nasal patency.

CONCLUSION

Objective and subjective measurements of TV and MCA increased after initiation of CPAP therapy in this prospective study.

The Role of Tonsillectomy in Adults with Tonsillar Hypertrophy and Obstructive Sleep Apnea

Objective To determine if tonsillectomy alone is an effective treatment in improving obstructive sleep apnea in adult subjects with tonsillar hypertrophy and to evaluate the effect of tonsillectomy on patient-reported quality-of-life indices. Study Design Case series with planned data collection. Setting Academic hospital. Subjects and Methods Thirty-four subjects completed enrollment and intervention from January 2011 to January 2016. Subjects completed pre- and postoperative quality-of-life questionnaires, including the Insomnia Severity Index, Epworth Sleepiness Scale, and the Functional Outcomes of Sleep Questionnaire-10. Surgical response to treatment was defined by a >50% decrease in the Apnea-Hypopnea Index and a decrease in the overall Apnea-Hypopnea Index to <20. Wilcoxon matched-pairs signed-rank tests were used to test each variable to assess for a change from pre- to postintervention. Subjects were then split into 3 BMI subgroups, with results also evaluated by Wilcoxon matched-pairs signed-rank tests. Results There was a significant difference discovered between the mean preoperative Apnea-Hypopnea Index of 31.57 and the mean postoperative value of 8.12 ( P < .001). All patient-reported outcomes improved significantly following tonsillectomy. After stratifying all outcome variables (Apnea-Hypopnea Index, Epworth Sleepiness Scale, Insomnia Severity Index, and Functional Outcomes of Sleep Questionnaire-10) by sex, race, and tonsil size, no statistically significant difference was noted among any of these subgroups. There was a 78% surgical response to treatment. Conclusion Tonsillectomy appears to be an effective treatment for obstructive sleep apnea in a select population of adults with tonsillar hypertrophy.

Nasal Surgery for Obstructive Sleep Apnea Syndrome

Obstructive sleep apnea is a common condition, primarily caused by narrowing of the nasal and pharyngeal airway. Treatment with continuous positive airway pressure (CPAP) is considered the first line of therapy, but long-term compliance is only about 40%, often because of nasal obstruction. Any nasal obstruction can worsen CPAP compliance. Treatment of the nasal obstruction with topical nasal steroid sprays or nasal dilators has been shown to improve sleep disordered breathing. Surgical treatment of nasal obstruction, has been shown to improve sleep disordered breathing, as well as CPAP requirement and compliance with CPAP.

Airway Resistance in Children with Obstructive Sleep Apnea Syndrome

STUDY OBJECTIVES

Enlarged tonsils and adenoids, the main cause of obstructive sleep apnea syndrome (OSAS) in children, results in upper airway (UA) loading. This contributes to the imbalance between structural and neuromotor factors ultimately leading to UA collapse during sleep. However, it is unknown whether this UA loading can cause elevated airway resistance (AR) during wakefulness. We hypothesized that children with OSAS have elevated AR compared to controls and that this improves after OSAS treatment.

METHODS

Case control study performed at an academic hospital. Children with OSAS and nonsnoring healthy controls underwent baseline polysomnography and spirometry, and AR measurement by body plethysmography while breathing via an orofacial mask. Children with OSAS repeated the previously mentioned tests after adenotonsillectomy.

RESULTS

31 OSAS participants (mean age ± SD = 9.7 ± 3.0 y, obstructive apnea-hypopnea index (OAHI) median [range] = 14.9 [2-58.7] events/h, body mass index [BMI] z = 1.5 ± 1) and 31 controls (age = 10.5 ± 2.5 y, P = 0.24; OAHI = 0.4 [0-1.4], P < 0.001; BMI z = 0.9 ± 1, P = 0.01) were tested. OSAS AR at baseline was 3.9 [1.5-10.3] cmH2O/L/sec and controls 2.8 [1.4 - 6.2] (P = 0.027). Both groups had similar spirometry results. 20 patients with OSAS were tested 6.4 ± 6.6 mo after adenotonsillectomy. OAHI decreased from 15.2 [2.1-58.7] to 0.5 [0 - 5.1] events/h postoperatively (P < 0.001), and AR decreased from 4.3 [1.5 - 10.3] to 2.8 [1.7 - 4.7] cmH2O/L/sec (P = 0.009).

CONCLUSIONS

Children with OSAS have elevated AR that decreases after treatment. This is likely because of upper airway loading secondary to adenotonsillar hypertrophy and may contribute to the increased frequency of respiratory diseases in untreated children with OSAS.

Upper airway resistance during growth: A longitudinal study of children from 8 to 17 years of age

OBJECTIVE

To study upper airway breathing in 115 children annually from 8 to 17 years of age with the hypothesis that upper airway respiratory needs increase steadily during growth and show sexual dimorphism.

MATERIAL AND METHODS

To calculate nasal resistance, airflow rate (mL/s) and oronasal pressures (cmH2O) were measured during rest breathing in a seated position using the pressure-flow technique.

RESULTS

Median values of oronasal pressure ranged at different ages in girls from 0.88 to 1.13 and in boys from 0.92 to 1.44 cmH2O, being 0.95 and 0.93 cmH2O at the age of 17 years, respectively. The gender differences were statistically significant in four age groups (P < .05 by the Mann-Whitney test). Mean values of nasal resistance decreased from 8 to 17 years of age in girls from 4.0 (±3.27) to 2.4 (±2.30) and in boys from 3.3 (±2.48) to 1.5 (±0.81) cmH2O/L/s. However, there was an increase in resistance in 11-year-old girls and 12-year-old boys and at the age of 15 in both genders (P < .05 by paired t-test).

CONCLUSIONS

Respiratory efforts stabilize oronasal pressure to maintain vital functions at optimal level. Nasal resistance decreased with age but increased temporarily at the prepubertal and pubertal phases, in accordance with other growth and possibly hormonal changes. When measuring upper airway function for clinical purposes, especially in patients with sleep apnea, asthma, allergies, cleft palate, or maxillary expansion, the measurements need to be compared with age- and gender-specific values obtained from healthy children.

Obstructive sleep apnea in Asian primary school children

PURPOSE

The objectives of this study were to examine the prevalence of obstructive sleep apnea (OSA) in primary school children, relationships between OSA and tonsillar hypertrophy, adenoid, and patency of the nasal cavity, and the effects of the tonsillar hypertrophy and adenoid on the nasal patency.

METHODS

An examination of the palatine tonsils and anterior rhinoscopy, completion of a questionnaire survey, a measurement of nasal resistance, an examination for sleep apnea at home using portable polysomnography device, and radiography of pharyngeal tonsil were performed in 152 primary school children.

RESULTS

The obstructive apnea hypopnea index (O-AHI) increased with enlargements in the palatine tonsils. The adenoidal nasopharyngeal ratio (A/N ratio) decreased with advances in grade. A significant difference was observed in the O-AHI between those with and without adenoid. The median value of the O-AHI increased with advances in grade. The nasal resistance was significantly higher in the group with adenoid compared as in the group without. It was also higher in the nasal disease group with OSA than in the group without. Full polysomnography(PSG) was recommended in 16 (10.5%) of 152 who underwent the examination using the portable polysomnography device, and of the eight who underwent PSG, six (75%) were confirmed to have OSA, while its prevalence in all subjects was estimated as 7.9%.

CONCLUSIONS

Disturbances in nasal respiration as well as tonsillar hypertrophy and adenoid were found to be a risk factor of OSA in primary school children.

Simultaneous Tonsillectomy and Nasal Surgery in Adult Obstructive Sleep Apnea

Objective

Although adenotonsillectomy is the accepted treatment for obstructive sleep apnea (OSA) in the pediatric population, tonsillectomy has not been widely adopted in adults, and its success in this group has not been well reported. Despite the lack of current evidence, there may be an important role for tonsillectomy in selected adult cases, and further study is required. This is a pilot study from a larger group of subjects currently enrolled and awaiting surgery and repeat polysomnography.

Study Design

Retrospective series with chart review.

Setting

Tertiary referral teaching hospitals.

Subjects and Methods

Thirteen consecutive eligible subjects with tonsillar hypertrophy and OSA were identified after treatment. These patients had undergone pre- and postoperative polysomnography for assessment of the severity of sleep-disordered breathing. Post hoc analysis of key parameters was performed by Wilcoxon signed rank and paired t tests. Tonsillectomy was performed on all subjects, using the diathermy dissection technique. Nasal surgery was performed simultaneously in 11 subjects for symptomatic nasal blockage unresponsive to medical treatment.

Results

There was a statistically significant improvement in the severity of OSA after surgery. The total Respiratory Disturbance Index (RDI) was significantly decreased from median values of 31.7 to 5.5 ( P = .0002). The RDI in rapid eye movement and non–rapid eye movement sleep and the arousal index were also significantly decreased.

Conclusion

In selected adult subjects, tonsillectomy with intercurrent nasal surgery should be considered an effective treatment for OSA and may reduce the requirement for continuous positive airway pressure, oral appliances, or further therapeutic intervention.

Nasal resistance in Japanese elementary schoolchildren: determination of normal value

CONCLUSION

Rhinomanometry is a useful method for evaluating nasal airway patency in schoolchildren, and we could confirm the validity of the results it produces.

OBJECTIVE

Our purpose was to assess the validity nasal resistance measurements produced using anterior active rhinomanometry by comparing the results with those of our previous study and to determine a normal value of the nasal resistance.

METHODS

Nasal resistance was measured by rhinomanometry in 852 children using the active anterior method.

RESULTS

Mean nasal resistance was 0.45 ± 0.70 Pa/cm(3)/s. Nasal diseases were noted in 358 (42%) children, and nasal condition was normal (the normal group) in 494 (58%) children. Nasal resistance was 0.57 ± 1.05 Pa/cm(3)/s in the nasal disease group and 0.35 ± 0.16 Pa/cm(3)/s in the normal group, showing that resistance was significantly higher in the nasal disease group. In the normal nasal groups, nasal resistance tended to be lower in the children in higher grades (first grade, 0.44 ± 0.17 Pa/cm(3)/s; second grade, 0.37 ± 0.11 Pa/cm(3)/s; third grade, 0.36 ± 0.23 Pa/cm(3)/s; fourth grade, 0.36 ± 0.14 Pa/cm(3)/s; fifth grade, 0.30 ± 0.08 Pa/cm(3)/s; sixth grade, 0.29 ± 0.11 Pa/cm(3)/s), and taller groups (<120 cm, 0.43 ± 0.16 Pa/cm(3)/s; 120-130 cm, 0.37 ± 0.19 Pa/cm(3)/s; 130-140 cm, 0.34 ± 0.12 Pa/cm(3)/s; >140 cm, 0.28 ± 0.09 Pa/cm(3)/s). Results similar to those seen in our previous study were obtained in each group.

Continuous positive airway pressure intolerance associated with elevated nasal resistance is possible mechanism of complex sleep apnea syndrome

PURPOSE

Complex sleep apnea syndrome (CompSAS) is diagnosed after an elimination of obstructive events with continuous positive airway pressure (CPAP), when a central apnea index ≥5/h or Cheyne-Stokes respiration pattern emerges in patients with obstructive sleep apnea syndrome (OSAS). However, the pathophysiology of CompSAS remains controversial.

METHODS

Of the 281 patients with suspected OSAS, all of whom underwent polysomnography conducted at Nagoya University Hospital, we enrolled 52 patients with apnea-hypopnea index ≥15/h (age 51.4 ± 13.3 years). The polysomnographic findings, left ventricular ejection fraction (LVEF), and nasal resistance were compared between the CompSAS patients and OSAS patients.

RESULTS

Forty-three patients were diagnosed with OSAS and nine patients with central sleep apnea syndrome by natural sleep PSG. Furthermore, 43 OSAS patients were classified into the OSAS patients (OSAS group, n = 38) and the CompSAS patients (CompSAS group, n = 5) by the night on CPAP PSG. The nasal resistance was significantly higher in CompSAS group than in OSAS group (0.30 ± 0.10 vs. 0.19 ± 0.07 Pa/cm(3)/s, P = 0.004). The arousal index, percentage of stage 1 sleep, and oxygen desaturation index were significantly decreased, and the percentage of stage REM sleep was significantly increased in the OSAS group with the initial CPAP treatment, but not in the CompSAS group. In addition, the patients with CompSAS showed normal LVEF.

CONCLUSION

CPAP intolerance secondary to an elevated nasal resistance might relate to frequent arousals, which could presumably contribute to an increase in central sleep apnea. Further evaluation in a large study is needed to clarify the mechanism of CompSAS.

Changes in hyoid bone position following rapid maxillary expansion in adolescents

OBJECTIVE

To examine changes in hyoid to mandibular plane distance (H-MP) and tongue length (TL) between children who had orthodontic treatment with and without rapid maxillary expansion (RME).

MATERIALS AND METHODS

Lateral and frontal cephalograms of 138 patients treated with RME and 148 controls treated without RME were used to measure pretreatment (T(1)) and posttreatment (T(2)) intermolar (IM) distance, lateronasal width (LNW), H-MP, and TL. Medical histories were used to collect demographic information, history of mouth breathing, difficulty breathing through the nose, and previous adenotonsillectomy. Groups were group-matched for age and gender. Descriptive statistics were calculated. Group means were compared using t-tests and chi-square statistics. Reliability was estimated using intraclass correlations and kappa statistics. Statistical significance was set at P < .05.

RESULTS

At T(1), the RME group showed smaller LNW (24.83 ± 1.99 vs 26.18 ± 2.05) and IM (50.17 ± 2.3 vs 51.58 ± 2.83). The distance from H-MP was longer in the RME group (15.69 ± 3.95 vs 13.86 ± 3.4). Mean changes (T(2) - T(1)) in the RME group were increased LNW (+2.48 ± 1.38 vs +0.94 ± 1.11 for the non-RME group) and IM (+3.21 ± 1.72 vs +0.98 ± 1.67). The mean change (T(2) - T(1)) in H-MP for the RME group was -0.68 ± 3.67 compared with +1.1 ± 2.96 for the non-RME group. Mean changes for TL were not statistically significant. No significant differences were noted at T(2) between groups for LNW, H-MP, or TL.

CONCLUSIONS

In this sample, RME produced significant changes in H-MP, and TL was unaffected.

Measurement of nasal resistance by rhinomanometry in 892 Japanese elementary school children

OBJECTIVE

The normal value of nasal resistance in adults has been reported (0.25 Pa/cm³/s), but that in children has not. In this study, we measured nasal resistance in Japanese school children by employing rhinomanometry.

METHODS

An otolaryngologist examined 939 Japanese school children with regard to the presence or absence of nasal diseases and tonsil size. Nasal resistance was measured by rhinomanometry employing the active anterior method in 892 children. A questionnaire concerning the condition during sleep, such as the presence or absence of snoring and sleep apnea syndrome, was performed.

RESULTS

The mean nasal resistance was 0.43 ± 0.50 Pa/cm³/s: 0.46 ± 0.65 and 0.39 ± 0.22 Pa/cm³/s in boys and girls, respectively. Of the 892 children, Grade 3 and 4 tonsil hypertrophy was noted in 84 (9%), but the presence of tonsil hypertrophy did not influence nasal resistance. Nasal diseases were noted in 335 children (38%) and the nasal condition was normal (the normal group) in 557 (62%). Nasal resistance was 0.56 ± 0.75 Pa/cm³/s in the nasal disease group and 0.36 ± 0.21 Pa/cm³/s in the normal group, showing that the resistance was significantly higher in the nasal disease group. The resistance tended to decrease as the school grade increased. In the normal group, 290 children (33%) experienced no problem regarding the upper airway, such as snoring and sleep apnea syndrome, based on a questionnaire, and nasal resistance was 0.35 ± 0.17 Pa/cm³/s.

CONCLUSION

This normal nasal resistance value may be adopted for the objective evaluation of nasal obstruction and effects of treatment in pediatric nasal diseases.

Role of allergy in sleep-disordered breathing

Sleep-related symptoms are extremely common in patients with allergic rhinitis. Sleep impairment is likely a major contributor to the overall disease morbidity, direct and indirect health care costs, and the loss of work productivity associated with allergic rhinitis. The association between allergic rhinitis and sleep, and the subsequent impact on disease-specific and general health quality of life measures, is well documented in large epidemiologic studies as well as controlled clinical trials. This article focuses on sleep disruption caused by allergic rhinitis, and the therapeutic and surgical options available to tackle the problem.

[Guideline: Treatment of obstructive sleep apnea in adults]

The current guideline discusses conservative and surgical therapy of obstructive sleep apnea (OSA) in adults from the perspective of the ear, nose and throat specialist. The revised guideline was commissioned by the German Society of Ear-Nose-Throat, Head-Neck Surgery (DG HNO KHC) and compiled by the DG HNO KHC's Working Group on Sleep Medicine. The guideline was based on a formal consensus procedure according to the guidelines set out by the German Association of Scientific Medical Societies (AWMF) in the form of a"S2e guideline". Research of the literature available on the subject up to and including December 2008 forms the basis for the recommendations. Evaluation of the publications found was made according to the recommendations of the Oxford Centre for Evidence-Based Medicine (OCEBM). This yielded a recommendation grade, whereby grade A represents highly evidence-based studies and grade D those with a low evidence base.

The role of the nose in the pathogenesis of obstructive sleep apnea

PURPOSE OF REVIEW

To define the relationship between obstructive sleep apnea (OSA) and nasal obstruction, we have reviewed the literature on epidemiological, physiological, and randomized controlled studies in which the relationship between nasal obstruction and OSA was investigated.

RECENT FINDINGS

Data from observational studies suggest that nasal obstruction contributes to the pathogenesis of OSA. Recently, studies have mainly focused on the effects of therapeutic interventions on the nose and OSA. Eleven trials with randomized controlled designs were found; external nasal dilators were used in five studies, topically applied steroids in one, nasal decongestants in three, and surgical treatment in two studies. Data from these studies showed only minor improvement in the symptoms and severity of OSA.

SUMMARY

The current evidence suggests that the nose may not play a significant role in the pathogenesis of OSA. The impact of treating nasal obstruction in patients with OSA on long-term outcome remains to be defined more accurately through randomized controlled trials of medical and surgical therapies with large numbers of patients.