What impact does nasal obstruction have on obstructive sleep apnea (OSA) as measured by polysomnography (PSG)?
Background: While nasal obstruction is often identified and treated in patients with OSA, its role in the pathogenesis or exacerbation of sleep-disordered breathing (SDB) has not been clearly shown. Several previous studies have used nasal packing or complete nasal obstruction to evaluate the effect of nasal breathing on OSA, with conflicting results.
Explore this issue:August 2011
Study Design: Non-randomized, prospective controlled study.
Setting: Tertiary care center in the U.S.
Synopsis: Forty-nine consecutive patients with snoring and nasal obstruction who underwent septoplasty had PSG before surgery and on the first post-operative night with nasal packing in place. After patients were stratified into mild OSA (RDI<15) or moderate/severe disease, nasal packing was found to cause significant increases in RDI, from 5.2 +/- 4.0 to 10.4 +/- 10.0 events/hour; in ODI, from 7.6 +/- 7.1 to 9.9 +/- 7.4; and in snoring duration, from 86.5% to 79.3% in the mild group only. Oxygen desaturation measures were not significantly changed with nasal obstruction in either group.
The authors hypothesize that patients with moderate or severe disease may already have multi-level obstruction or be mouth breathers at baseline. Thus, nasal obstruction alone does not have the significant effect that it has on those with mild OSA. This suggests that in patients with mild OSA, nasal obstruction may play a more prominent role and that treatment of nasal symptoms may improve both quality of life and PSG measures of SDB. For patients with moderate or severe disease, however, nasal surgery would not appear to significantly improve either snoring or OSA disease severity.
Bottom Line: Patients with mild OSA were noted to have an exacerbation of OSA with nasal obstruction, while those with moderate and severe disease did not.
Citation: Friedman M, Maley A, Kelley K, et al. Impact of nasal obstruction on obstructive sleep apnea. Otolaryngol Head Neck Surg. 2011;144(6):1000-1004.
-Reviewed by Stacey Ishman, MD