The importance of nose-breathing for the systolic blood pressure rise during exercise

Improvement of the aerobic performance in endurance athletes presenting nasal valve compromise with the application of an internal nasal dilator

PURPOSE

We investigated the effects of an internal nasal dilator on nasal airflow and cardio-respiratory capacity in adult endurance athletes, while performing controlled exhaustive physical exercise.

METHODS

Prospective observational study. Participants were 38 adult endurance athletes, 23 with and 15 without nasal valve compromise. Nasal patency was objectively evaluated with anterior rhinomanometry, acoustic rhinometry and peak nasal inspiratory flow (PNIF). Maximum oxygen uptake (VO2max), maximum pulmonary ventilation, time to exhaustion and total time of nasal respiration were recorded during a submaximal treadmill test. Dyspnea intensity and fatigue perception were evaluated using a labeled visual analog scale. All assessments were performed with and without the application of the internal nasal dilator.

RESULTS

All the parameters related to aerobic capacity were significantly reduced in the group of athletes with nasal valve compromise (p. <0.05 for all variables). The internal nasal dilator improved statistically significantly the nasal patency (p. <0.001), VO2max and aerobic performance and self-rating of dyspnea and fatigue (p. <0.05 for all parameters) only in athletes with nasal obstruction. PNIF correlated significantly with VO2max (rho = 0.4, p. <0.05).

CONCLUSIONS

Internal nasal dilation improves nasal patency and aerobic performance during submaximal exercise in adult endurance athletes with nasal obstruction symptoms due to nasal valve compromise.

A Comparison of Over-the-Counter Mechanical Nasal Dilators: A Systematic Review

IMPORTANCE

The internal nasal valve is the narrowest part of the nasal airway and a common site of inspiratory collapse and obstruction of nasal airflow. Over-the-counter mechanical nasal dilators are an alternative to surgical intervention that attempts to improve airflow through the internal nasal valve.

OBJECTIVE

To determine the efficacy of over-the-counter mechanical nasal dilators and classify these products by mechanism.

EVIDENCE REVIEW

A database of 33 available over-the-counter mechanical nasal dilators was generated via a PubMed search as well as an internet search via Amazon.com and Google, conducted from April 1, 2013, through December 31, 2015. Products determined to be unavailable or discontinued were excluded from the database. Of the devices examined in published literature, efficacy was based on objective measures, such as measured airflow, the cross-sectional area of the nasal valve, and changes in resistance. Measures of reported sleep quality or patient perception were excluded.

FINDINGS

An analysis of each product's mechanism revealed 4 broad classes: external nasal dilator strips, nasal stents, nasal clips, and septal stimulators. A review demonstrated 5 studies supporting the use of external nasal dilator strips, 4 studies supporting the use of nasal clips, 1 study supporting the use of nasal stents, and no studies supporting the use of septal stimulators.

CONCLUSIONS AND RELEVANCE

Our findings suggest that external nasal dilator strips and nasal clips effectively relieve obstruction of the internal nasal valve and may be an alternative to surgical intervention in some patients.

Clinical evaluation of a novel internal nasal dilation stent for the improvement of nasal breathing

OBJECTIVE

This study assessed rhinometric improvement in nasal airflow, perceived comfort, and the utility of nasal dilation devices for individuals with nasal obstruction treated with an external nasal dilator (END) or a novel internal nasal dilation stent (INDS).

STUDY DESIGN

Prospective, randomized, crossover trial.

SUBJECTS

Individuals with symptoms of nasal obstruction.

METHODS

Twenty-three participants underwent rhinometry and a trial with a novel INDS and a validated END. Devices were used in a randomized, crossover fashion. Nasal airflow, maximum use, continuous use, comfort, and challenge with these devices were assessed.

RESULTS

The END and INDS showed greater nasal airflow from baseline, with the INDS being significantly better than the END. The INDS was used significantly more than the END, and demonstrated significantly greater comfort and less associated challenge.

CONCLUSIONS

The novel INDS showed 3.4 times improved nasal airflow from baseline, was used maximally and continuously longer than a validated END, and was judged to be significantly more tolerable.

The importance of improved nasal breathing: a review of the Nozovent nostril dilator

The Nozovent nostril dilator improves nasal breathing to the same degree as topical decongestants and reduces mouth dryness at night in 51% of nocturnal mouth breathers. It does not help every snorer but reduces the snoring heard by the sleeping partner in about 50%, improves the respiratory disturbance index significantly in 19% and gives less morning and daytime tiredness in 40% of snorers. The medium CPAP pressure can be significantly reduced with the dilator.

Dichotomous physiological effects of nocturnal external nasal dilation in heavy snorers: the answer to a rhinologic controversy?

The purpose of this article was to study the impact of external dilation on nasal airway dimensions, sleep architecture, and snoring. Eighteen heavy snorers without severe obstructive sleep apnea syndrome (mean apnea-hypopnea index (AHI) 9.3) reporting nocturnal nasal obstruction were enrolled in a randomized (controlled) cross-over study, evaluating subjective and objective effects of external nasal dilation (Breathe Right, 3M). The active dilator was also worn during a one-week pretrial run-in period. Polysomnography, recording of snoring sounds, and repeated acoustic rhinometry were performed on two consecutive nights, one with the active dilator and one with a placebo strip. The significant subjective improvement reported during the run-in period compared to the preceding period without dilator (p < 0.01), remained only for nasal patency (p < 0.05) when comparing the two nights in the sleep laboratory. The nasal dimensions increased significantly (p < 0.001) with the active dilator compared to placebo, both in the evening and the next morning. In a subgroup (n = 6) of habitual snorers (AHI < 10) with severe morning obstruction (combined minimal cross-sectional area < 0.6 cm2), external dilation significantly improved the mean sleep PaSO2 (92.4 --> 96.7) and the percentage of sleep with a PaSO2 < 95% (49.9% --> 4.9%) (p < 0.05). In this subgroup there was a trend toward reduction in (7.4 --> 5.4) (p = 0.06), whereas the AHI increased significantly in the group of 12 with larger nocturnal nasal dimensions (p < 0.05). Duration and intensity of snoring remained unchanged regardless of the subgrouping. Objective beneficial effects were restricted to nocturnal oxygen saturation and AHI in a subgroup of habitual heavy snorers identified by repeated acoustic rhinometry, in whom external dilation objectively relieved marked nocturnal nasal obstruction. This finding may provide a logical explanation for the conflicting results of medical, surgical, and mechanical expansion of the nasal dimensions on snoring and sleep disturbances. (American

The nasal airway and obstructed breathing during sleep

Nasal obstruction whether partial or complete can influence the quality of sleep and has been strongly linked to the genesis of obstructed breathing during sleep (OBS). The relationship between nasal airflow and the process of upper airway collapse is complex. The first part of this article reviews the nasal anatomy with an emphasis on the sites of nasal obstruction, the effect of the nasal reflexes on the pulmonary system, and the pathophysiology of the development of OBS. The second part reviews the common causes of increased nasal resistance, the assessment of nasal passages, and the treatment options. This article also includes literature in support of and refuting the postulated mechanisms by which nasal obstruction can effect the respiratory system during sleep.

Physical dilatation of the nostrils lowers the thermal strain of exercising humans

Increased nasal air flow during exercise was examined as a possible heat loss avenue contributing to selective brain cooling in hyperthermic humans. On 2 separate days, eight subjects [mean (SE) age, 26.4 (1.2) years] exercised on a cycle ergometer in a warm room [28 (0.2) degrees C; 28 (5)% relative humidity] to induce a moderate level of hyperthermia. In one session the nostrils were physically dilatated [average dilatation 1.55 (0.17) times] and in the other they were not (control). Both sessions started with a 5-min resting period; then subjects pedaled at 60 W for 5 min, 100 W for 15 min, and 150 W for 20 min. During dilatation both tympanic temperature (Tty) and forehead skin blood flow, estimated by laser doppler velocimetry, were significantly lower than during the control exercise of 150 W. Rates of increase of Tty during the 100-W exercise were the same in both conditions; however, during the 150-W exercise with dilatated nostrils Tty increased at a rate significantly lower than during control [1.1 (0.3) degrees C.h-1 vs 1.5 (0.4) degrees C.h-1]. The change in the rate of increase of Tty between conditions was significantly correlated to the degree of nostril dilatation (r = -0.77, P = 0.02), suggesting that the lower Tty observed was due to nostril dilatation. Facial skin temperature was not significantly different between sessions. The results suggest that the nasal cavity may act as a heat exchanger in selective brain cooling of exercising humans.