Nasal Resistance in Obstructive Sleep Apnea

Atkins, Mark; Taskar, Varsha; Clayton, Nigel; Stone, Patricia W.; Woodcock, Ashley

doi:10.1378/chest.105.4.1133

Cited by 67 publications

(44 citation statements)

References 14 publications

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“…However, it requires that the patient breathe in a nonnatural way during the investigation, and it involves use of Ohm's law for parallel resistors, which is reliable only for the decongested note [18] for total nasal resistance calculation. ATKINS et al [12] reported that anterior rhinomanometry failed to demonstrate any differences in nasal resistance between OSAS and nonOSAS patients. However, their sample size was limited to 71 OSAS patients and 70 nonOSAS snorers.…”

Section: Discussionmentioning

confidence: 99%

Nasal obstruction as a risk factor for sleep apnoea syndrome

Lofaso¹,

Coste²,

d’Ortho³

et al. 2000

Eur Respir J

215

139

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Nasal obstruction has frequently been mentioned as a possible risk factor in obstructive sleep apnoea syndrome (OSAS). Over a 2‐yr period, 541 unselected consecutive snorers referred for suspected breathing disorders during sleep were included to undergo posterior rhinomanometry. In addition cephalometric landmarks and body mass index (BMI) were obtained. Polysomnography was used to determine the number of abnormal respiratory events that occurred during sleep. OSAS was defined as 15 episodes, or more, of apnoea or hypopnoea per hour of sleep (AHI). Of the 541 consecutive snorers 528 underwent nasal resistance measurement by posterior rhinomanometry (failure rate: 2.4%). Patients with OSAS (259 patients) had higher nasal resistance than patients without OSAS (2.6±1.6 hPa·L·s‐1versus 2.2±1.0 hPa·L·s‐1, respectively, p<0.005). A stepwise multiple regression analysis showed that BMI, male sex, nasal resistance, and cephalometric parameters were contributing factors to the AHI. The r2‐value of the multiple regression analysis was 0.183. Nasal resistance contributed 2.3% of the variance (p<0.0001), whereas mandibular plane‐hyoid distance, BMI, male sex and age contributed 6.2%, 4.6%, 3% and 1.3% of the variance, respectively. To conclude, daytime nasal obstruction is an independent risk factor for OSAS.

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Section: Discussionmentioning

confidence: 99%

Nasal obstruction as a risk factor for sleep apnoea syndrome

Lofaso¹,

Coste²,

d’Ortho³

et al. 2000

Eur Respir J

215

139

View full text Add to dashboard Cite

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“…Nasal obstruction during sleep has been associated with an increased frequency of obstructive apnoeas and hypopnoeas [6][7][8][9][10]. If a given subject has partial or total nasal obstruction, they must breathe through the mouth.…”

mentioning

confidence: 99%

High Mallampati score and nasal obstruction are associated risk factors for obstructive sleep apnoea

Liistro¹,

Rombaux²,

Belge³

et al. 2003

Eur Respir J

150

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Induced nasal obstruction can cause obstructive apnoeas in healthy subjects during sleep, but the relationship between nasal resistance measured during wakefulness and obstructive sleep apnoea syndrome (OSAS) is weak. It was postulated that if the subjects could not breathe through the nose, the oral airway must be used, but if this airway is narrowed as well, then it could precipitate sleep-disordered breathing (SDB).Nasal patency, Mallampati score (MS), neck circumference and body mass index were measured in 202 subjects referred to the authors9 hospital to undergo a full-night polysomnography for suspicion of SDB.A significant correlation was found between the MS and apnoea/hypopnoea index measured during sleep. However, the relationship between these parameters was only significant in patients with nasal obstruction. The relative risk of having OSAS with a MS of III or IV was 1.95 for the whole group and 2.45 in patients with nasal obstruction.In conclusion, a high Mallampati score represents a predisposing factor for obstructive sleep apnoea syndrome, especially if it is associated with nasal obstruction. These patients merit special attention from both the sleep physician and the anaesthetist.

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“…Some authors have reported that surgical correction of severe nasal obstruction results in differing degrees of improvement in OSA between individuals, indicating that it is difficult to predict the degree of improvement (2,14,17). Ibrahim and Sayed (9) reported that the severity of preoperative nasal obstruction and snoring did not influence the improvement of symptoms after septoplasty.…”

Section: Effects Of Nasal Anatomical Abnormalities On Osamentioning

confidence: 99%

“…Epidemiological studies have found relationships between a history of nasal stuffiness and snoring (8) and between measured nasal airflow and a history of snoring (3), but attempts to find a linear correlation between nasal obstruction and sleep-disordered breathing have been less successful (2,30,34). However, a weak correlation between nasal resistance measured by means of posterior rhinomanometry and the severity of sleep apnea has recently been reported (15).…”

Section: Introductionmentioning

confidence: 99%

Effects of Nasal Pathologies on Obstructive Sleep Apnea

Enöz

2007

Acta Med. (Hradec Kralove, Czech Repub.)

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Many abnormalities of the nose and pharynx can cause or aggravate snoring and sleep apnea. Nasal septal deviation, nasal polyps, inferior turbinate hypertrophy and rhinitis can cause nasal airway obstructions. Adenoid hypertrophy, nasopharyngitis and nasopharyngeal tumors can cause nasopharyngeal airway narrowing (6).Epidemiological studies have found relationships between a history of nasal stuffiness and snoring (8) and between measured nasal airflow and a history of snoring (3), but attempts to find a linear correlation between nasal obstruction and sleep-disordered breathing have been less successful (2,30,34). However, a weak correlation between nasal resistance measured by means of posterior rhinomanometry and the severity of sleep apnea has recently been reported (15).Several studies have shown that increased nasal resistance may induce sleep-related breathing disorders (SRBD) and cause disturbed sleep (7, 8); however, contradictory results have also been obtained (12). PathophysiologyThree interacting factors play a critical role in obstruction of the upper airway in OSAS: the muscle activity of the dilators of the pharyngeal airway, the negative pressure generated during inspiration, which opposes the activity of the dilators, and the structural anatomy of the airway (7, 31).Mouth opening, independent of the breathing route, is believed to increase the collapsibility of the upper airways as a result of a decrease in the contractility of the upper airway muscles (20).The biologic basis for nasal obstruction as a cause of sleep-disordered breathing lies in the effect of nasal breathing on resistance and flow velocity, which affects the pressure differential between the atmosphere and the intrathoracic space (34). Partial or complete obstruction can occur when the intrathoracic negative pressure generated by the inspiratory muscles pulls on the compliant soft tissue in the upper airway, sucking the airway closed (26). It is worth pointing out that the nose accounts for half of the total respiratory system resistance (24). Nasal obstruction leads to various breathing disturbances, including an increase in sleep apnea-hypopnea and a reduced nocturnal lowest SpO 2 (23, 33).Although the primary site of obstruction in patients with OSAS is believed to be the oropharyngeal-hypopharyngeal region (Fig. 1), numerous studies examining the effects of experimentally-induced nasal obstruction on OSAS have indicated a positive and significant association (7,23,32,36). Therefore, nasal obstruction constitutes a predisposing factor for OSAS (1,3,23,32,36). Effects of nasal pathologies on OSA are summarized in Fig. 2. Effects of Allergic Rhinitis on OSAThe prevalence rate of allergic rhinitis is increasing by 3.5 % per decade and is estimated to be 15-25 % in Europe (29).In general, allergic rhinitis constitutes a pathologic condition characterized by a transient increase in nasal airway resistance due to mucosal swelling (16,18,22,25) and therefore theoretically constitutes a risk factor for OSAS.Several reports in which ...

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Nasal Resistance in Obstructive Sleep Apnea

Cited by 67 publications

References 14 publications

Nasal obstruction as a risk factor for sleep apnoea syndrome

Nasal obstruction as a risk factor for sleep apnoea syndrome

High Mallampati score and nasal obstruction are associated risk factors for obstructive sleep apnoea

Effects of Nasal Pathologies on Obstructive Sleep Apnea

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