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

Current Opinion in Otolaryngology and Head and Neck Surgery

Volumn 17, Issue 1, 2009, Pages 33-37

  Kohler, Malcolm ^a,b   Bloch, Konrad E ^a,c   Stradling, John R ^b  

^a UNIVERSITY HOSPITAL ZURICH   (Switzerland)

^b Oxford Centre for Respiratory Medicine   (United Kingdom)

^c UNIVERSITY OF ZURICH   (Switzerland)

Author keywords

Nasal obstruction; Nose; Obstructive sleep apnea

Indexed keywords

FLUTICASONE; PLACEBO; XYLOMETAZOLINE;

CLINICAL TRIAL; CONTROLLED CLINICAL TRIAL; DEVICE THERAPY; DISEASE ASSOCIATION; DISEASE SEVERITY; HUMAN; NOSE DILATOR; NOSE OBSTRUCTION; NOSE SEPTUM RECONSTRUCTION; NOSE SURGERY; PATHOGENESIS; PRIORITY JOURNAL; PROSTHESIS; RANDOMIZED CONTROLLED TRIAL; REVIEW; SLEEP APNEA SYNDROME; SNORING; TREATMENT DURATION; BREATHING MECHANICS; FEMALE; FOLLOW UP; HOSPITALIZATION; INCIDENCE; MALE; PATHOPHYSIOLOGY; RISK ASSESSMENT;

FEMALE; FOLLOW-UP STUDIES; HUMANS; INCIDENCE; MALE; NASAL OBSTRUCTION; RANDOMIZED CONTROLLED TRIALS AS TOPIC; RESPIRATORY MECHANICS; RISK ASSESSMENT; SEVERITY OF ILLNESS INDEX; SLEEP APNEA, OBSTRUCTIVE;

EID: 66149149521     PISSN: 10689508     EISSN: None     Source Type: Journal    
DOI: 10.1097/MOO.0b013e32831b9e17     Document Type: Review

References (56)

1. Stradling JR. Obstructive sleep apnoea: definitions, epidemiology, and natural history. Thorax 1995; 50:683-689.
2. Young T, Palta M, Dempsey J, et al. The occurence of sleep disordered breathing among middle aged adults. N Engl J Med 1993; 328:1230-1235.
3. Jenkinson C, Davies RJ, Mullins R, Stradling JR. Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised prospective parallel trial. Lancet 1999; 353:2100-2105. (Pubitemid 29278478)
4. Pepperell JCT, Ramdassingh-Dow S, Crosthwaite N, et al. Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial. Lancet 2002; 359:204-210. (Pubitemid 34113817)
5. Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005; 365:1046-1053. (Pubitemid 40386782)
6. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 2002; 165:1217-1239. (Pubitemid 34461732)
7. Stradling JR, Crosby J. Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle-aged men. Thorax 1991; 46:85-90.
8. Liistro G, Rombaux P, Belge C, et al. High Mallampati score and nasal obstruction are associated risk factors for obstructive sleep apnoea. Eur Respir J 2003; 21:248-252. (Pubitemid 36204538)
9. Lofaso F, Coste A, d'Ortho MP, et al. Nasal obstruction as a risk factor for sleep apnoea syndrome. Eur Respir J 2000; 16:639-643.
10. Schwartz AR, Smith PL, Wise RA, et al. Induction of upper airway occlusion in sleeping individuals with subatmospheric nasal pressure. J Appl Physiol 1988; 64:535-542.
11. Smith PL, Wise RA, Gold AR, et al. Upper airway pressure-flow relationships in obstructive sleep apnea. J Appl Physiol 1988; 64:789-795. (Pubitemid 18069936)
12. Young T, Finn L, Kim H. Nasal obstruction as a risk factor for sleep-disordered breathing. The University of Wisconsin Sleep and Respiratory Research Group. J Allergy Clin Immunol 1997; 99:757-762.
13. Young T, Finn L, Palta M. Chronic nasal congestion at night is a risk factor for snoring in a population-based cohort study. Arch Intern Med 2001; 161: 1514-1519. (Pubitemid 32679564)
14. Fitzpatrick MF, McLean H, Urton AM, et al. Effect of nasal or oral breathing route on upper airway resistance during sleep. Eur Respir J 2003; 22:827-832. (Pubitemid 37369574)
15. Suratt PM, Turner BL, Wilhoit SC. Effect of intranasal obstruction on breathing during sleep. Chest 1986; 90:324-329.
16. Lavie P, Fischel N, Zomer J, Eliaschar I. The effects of partial and complete mechanical occlusion of the nasal passages on sleep structure and breathing in sleep. Acta Otolaryngol 1983; 95:161-166. (Pubitemid 13206212)
17. Zwillich CW, Pickett C, Hanson FN, Weil JV. Disturbed sleep and prolonged apnea during nasal obstruction in normal men. Am Rev Respir Dis 1981; 124:158-160. (Pubitemid 11044492)
18. Lee SH, Choi JH, Shin C, et al. How does open-mouth breathing influence upper airway anatomy? Laryngoscope 2007; 117:1102-1106.
19. McNicholas WT, Coffrey M, Boyle T. Effects of nasal airflow on breathing during sleep in normal humans. Am Rev Respir Dis 1993; 147:620-623. (Pubitemid 23072651)
20. Douglas NJ, White DP, Weil JV, Zwillich CW. Effect of breathing route on ventilation and ventilatory drive. Respir Physiol 1983; 51:209-218.
21. Basner RC, Simon PM, Schwartzstein RM, et al. Breathing route influences upper airway muscle activity in awake normal adults. J Appl Physiol 1989; 66:1766-1771.
22. Shi YX, Seto-Poon M, Wheatley JR. Breathing route dependence of upper airway muscle activity during hyperpnea. J Appl Physiol 1998; 84:1701-1706. (Pubitemid 28225911)
23. Williams JS, Janssen PL, Fuller DD, Fregosi RF. Influence of posture and breathing route on neural drive to upper airway dilator muscles during exercise. J Appl Physiol 2000; 89:590-598.
24. Koutsourelakis I, Vagiakis E, Roussos C, Zakynthinos SG. Obstructive sleep apnoea and oral breathing in patients free of nasal obstruction. Eur Respir J 2006; 28:1222-1228. (Pubitemid 44883860)
25. Zeng B, Ng AT, Qian J, et al. Influence of nasal resistance on oral appliance treatment outcome in obstructive sleep apnea. Sleep 2008; 31:543-547. Interesting observational study suggesting that high nasal resistance has a negative impact on oral appliance treatment efficacy in patients with OSA. (Pubitemid 351694276)
26. Morris LG, Burschtin O, Lebowitz RA, et al. Nasal obstruction and sleepdisordered breathing: a study using acoustic rhinometry. Am J Rhinol 2005; 19:33-39. (Pubitemid 40444002)
27. Leger D, Annesi-Maesano I, Carat F, et al. Allergic rhinitis and its consequences on quality of sleep: an unexplored area. Arch Intern Med 2006; 18:1744-1748. (Pubitemid 44414463)
28. Canova CR, Downs SH, Koblauch A, et al. Increased prevalence of perennial allergic rhinitis in patients with obstructive sleep apnea. Respiration 2004; 71:138-143.
29. McNicholas WT, Tarlo S, Cole P, et al. Obstructive apneas during sleep in patients with seasonal allergic rhinitis. Am Rev Respir Dis 1982; 126:625-628.
30. Craig TJ, Teets S, Lehman EB, et al. Nasal congestion secondary to allergic rhinitis as a cause of sleep disturbance and daytime fatigue and the response to topical nasal corticosteroids. J Allergy Clin Immunol 1998; 101:633-637. (Pubitemid 28228307)
31. Craig TJ, Mende C, Hughes K, et al. The effect of topical nasal fluticasone on objective sleep testing and the symptoms of rhinitis, sleep, and daytime somnolence in perennial allergic rhinitis. Allergy Asthma Proc 2003; 24:53-58. (Pubitemid 37034208)
32. Hughes K, Glass C, Ripchinski M, et al. Efficacy of the topical nasal steroid budesonide on improving sleep and daytime somnolence in patients with perennial allergic rhinitis. Allergy 2003; 58:380-385. (Pubitemid 36605725)
33. Craig TJ, Hanks CD, Fisher LH. How do topical nasal corticosteroids improve sleep and daytime somnolence in allergic rhinitis. J Allergy Clin Immunol 2005; 116:1264-1266.
34. Series F, St Pierre S, Carrier G. Effects of surgical correction of nasal obstruction in the treatment of obstructive sleep apnea. Am Rev Respir Dis 1992; 146:1261-1265.
35. Series F, St Pierre S, Carrier G. Surgical correction of nasal obstruction in the treatment of mild sleep apnea: importance of cephalometry in predicting outcome. Thorax 1993; 48:360-363. (Pubitemid 23126303)
36. Dayal V, Phillipson E. Nasal surgery in the management of sleep apnea. Ann Otorhinolaryngol 1985; 94:550-554. (Pubitemid 16172373)
37. Fairbanks D. Effect of nasal surgery on snoring. South Med J 1985; 78:268-270.
38. Friedman M, Tanyeri H, Lim JW, et al. Effect of improved nasal breathing on obstructive sleep apnea. Otolaryngol Head Neck Surg 2000; 122:71-74. (Pubitemid 30051693)
39. Virkkula P, Bachour A, Hytonen M, et al. Snoring is not relieved by nasal surgery despite improvement in nasal resistance. Chest 2006; 129:81-87. (Pubitemid 43265246)
40. Li HY, Lin Y, Chen NH, et al. Improvement in quality of life after nasal surgery alone for patients with obstructive sleep apnea and nasal obstruction. Arch Otolaryngol Head Neck Surg 2008; 134:429-433. Nonrandomized study in 51 patients with OSA looking at the effects of nasal septomeatoplasty on quality of life. (Pubitemid 351581093)
41. Nakata S, Miyazaki S, Ohki M, et al. Reduced nasal resistance after simple tonsillectomy in patients with obstructive sleep apnea. Am J Rhinol 2007; 21:192-195. (Pubitemid 46846350)
42. Koutsourelakis I, Georgoulopoulos G, Perraki E, et al. Randomised trial of nasal surgery for fixed nasal obstruction in obstructive sleep apnoea. Eur Respir J 2008; 31:110-117. This is currently the only randomized controlled study looking at the effects of nasal surgery on objective parameters of OSA severity.
43. Powell NB, Zonato AI, Weaver EM, et al. Radiofrequency treatment of turbinate hypertrophy in subjects using continuous positive airway pressure: a randomized, double-blind, placebo-controlled clinical pilot trial. Laryngoscope 2001; 111:1783-1790.
44. Bahammam AS, Tate R, Manfreda J, Kryger MH. Upper airway resistance syndrome: effect of nasal dilation, sleep stage, and sleep position. Sleep 1999; 22:592-598. (Pubitemid 29379116)
45. Djupesland PG, Skatvedt O, Borgersen AK. Dichotomous physiological effects of nocturnal external nasal dilation in heavy snorers: the answer to a rhinologic controversy? Am J Rhinol 2001; 15:95-103.
46. Pevernagie D, Hamans E, Van Cauwenberge P, Pauwels R. External nasal dilation reduces snoring in chronic rhinitis patients: a randomized controlled trial. Eur Respir J 2000; 15:996-1000. (Pubitemid 30399266)
47. Hoijer U, Ejnell H, Hedner J, et al. The effects of nasal dilation on snoring and obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 1992; 118:281-284.
48. Schonhofer B, Kerl J, Suchi S, et al. Effect of nasal valve dilation on effective CPAP level in obstructive sleep apnea. Respir Med 2003; 97:1001-1005. (Pubitemid 37098764)
49. Kiely JL, Nolan P, McNicholas WT. Intranasal corticosteroid therapy for obstructive sleep apnoea in patients with co-existing rhinitis. Thorax 2004; 59:50-55. (Pubitemid 38067972)
50. Kerr P, Millar T, Buckle P, Kryger M. The importance of nasal resistance in obstructive sleep apnea syndrome. J Otolaryngol 1992; 21:189-195.
51. McLean HA, Urton AM, Driver HS, et al. Effect of treating severe nasal obstruction on the severity of obstructive sleep apnoea. Eur Respir J 2005; 25:521-527.
52. Clarenbach CF, Kohler M, Senn O, et al. Does nasal decongestion improve obstructive sleep apnea? J Sleep Res 2008; [Epub ahead of print] Randomized and placebo-controlled trial in patients with OSA and chronic nasal congestion looking at the effects of topical nasal decongestion on OSA severity, sleep and continuous nocturnal resistance. In this study an interesting and novel technique was used to measure nasal resistance continuously during the whole sleep study.
53. Kohler M, Thurnheer R, Bloch KE. Side-selective, unobtrusive monitoring of nasal airflow and conductance. J Appl Physiol 2006; 101:1760-1765. (Pubitemid 44904499)
54. Kohler M, Thurnheer R, Bloch KE. Noninvasive, side-selective nasal airflow monitoring. Physiol Meas 2005; 26:69-82. (Pubitemid 41223592)
55. Kohler M, Clarenbach CF, Thurnheer R, Bloch KE. Perception of nocturnal nasal obstruction in chronic rhinitis. Eur Respir J 2005; 26 (supplement 49): 565.
56. Stradling JR, Barbour C, Glennon J, et al. Prevalence of sleepiness and its relation to autonomic evidence of arousals and increased inspiratory effort in a community based population of men and women. J Sleep Res 2000; 9:381-388. (Pubitemid 32050052)