Topical nasal treatment efficacy on adult obstructive sleep apnea severity: a systematic review and meta‐analysis

Nguyen, Dang-Khoa; Liang, Jonathan; Durr, Megan L.

doi:10.1002/alr.22658

Cited by 7 publications

(2 citation statements)

References 45 publications

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“…Approximately 30% of patients with allergic rhinitis may have chronic rhinosinusitis with or without nasal polyposis, approximately 13.5% may have migraine or tension headaches, and approximately 25% may have sleep disturbances such as obstructive sleep apnea. [29][30][31][32] For these patients, treating allergic rhinitis may improve the coexisting medical condition. 3…”

Section: Comorbid Conditionsmentioning

confidence: 99%

Allergic Rhinitis

Bernstein,

Makol

et al. 2024

JAMA

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ImportanceAllergic rhinitis affects an estimated 15% of the US population (approximately 50 million individuals) and is associated with the presence of asthma, eczema, chronic or recurrent sinusitis, cough, and both tension and migraine headaches.ObservationsAllergic rhinitis occurs when disruption of the epithelial barrier allows allergens to penetrate the mucosal epithelium of nasal passages, inducing a T-helper type 2 inflammatory response and production of allergen-specific IgE. Allergic rhinitis typically presents with symptoms of nasal congestion, rhinorrhea, postnasal drainage, sneezing, and itching of the eyes, nose, and throat. In an international study, the most common symptoms of allergic rhinitis were rhinorrhea (90.38%) and nasal congestion (94.23%). Patients with nonallergic rhinitis present primarily with nasal congestion and postnasal drainage frequently associated with sinus pressure, ear plugging, muffled sounds and pain, and eustachian tube dysfunction that is less responsive to nasal corticosteroids. Patients with seasonal allergic rhinitis typically have physical examination findings of edematous and pale turbinates. Patients with perennial allergic rhinitis typically have erythematous and inflamed turbinates with serous secretions that appear similar to other forms of chronic rhinitis at physical examination. Patients with nonallergic rhinitis have negative test results for specific IgE aeroallergens. Intermittent allergic rhinitis is defined as symptoms occurring less than 4 consecutive days/week or less than 4 consecutive weeks/year. Persistent allergic rhinitis is defined as symptoms occurring more often than 4 consecutive days/week and for more than 4 consecutive weeks/year. Patients with allergic rhinitis should avoid inciting allergens. In addition, first-line treatment for mild intermittent or mild persistent allergic rhinitis may include a second-generation H1 antihistamine (eg, cetirizine, fexofenadine, desloratadine, loratadine) or an intranasal antihistamine (eg, azelastine, olopatadine), whereas patients with persistent moderate to severe allergic rhinitis should be treated initially with an intranasal corticosteroid (eg, fluticasone, triamcinolone, budesonide, mometasone) either alone or in combination with an intranasal antihistamine. In contrast, first-line therapy for patients with nonallergic rhinitis consists of an intranasal antihistamine as monotherapy or in combination with an intranasal corticosteroid.Conclusions and RelevanceAllergic rhinitis is associated with symptoms of nasal congestion, sneezing, and itching of the eyes, nose, and throat. Patients with allergic rhinitis should be instructed to avoid inciting allergens. Therapies include second-generation H1 antihistamines (eg, cetirizine, fexofenadine, desloratadine, loratadine), intranasal antihistamines (eg, azelastine, olopatadine), and intranasal corticosteroids (eg, fluticasone, triamcinolone, budesonide, mometasone) and should be selected based on the severity and frequency of symptoms and patient preference.

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Section: Comorbid Conditionsmentioning

confidence: 99%

Allergic Rhinitis

Bernstein,

Makol

et al. 2024

JAMA

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“…Furthermore, factors affecting CPAP adherence include patient characteristics (age, nasal cavity volume and nasal resistance, level of understanding of CPAP, self-efficacy, and presence of a bed partner) and medical factors (operability of CPAP equipment, adverse events due to use of CPAP mask interface systems and high pressure during CPAP use, disease requiring long-term treatment [associated with non-radical therapy], CPAP setting and effectiveness, treatment-related factors such as cost, communication between patients and medical staff, patient education, cognitive behavioral therapy, and remote monitoring and/or telephone intervention) [7,14,15,19]. Among these factors, the improvement of nasal resistance by topical treatment contributes to an increase in life quality, but does not ameliorate the apnea-hypopnea index (AHI) [20,21] or affect the severity of OSA. Furthermore, high nasal resistance complicates CPAP continuation [22,23].…”

Section: Introductionmentioning

confidence: 99%

The relationship between adherence to continuous positive airway pressure and nasal resistance measured by rhinomanometry in patients with obstructive sleep apnea syndrome

Fujito

Ohshima²,

Hokari³

et al. 2023

PLoS ONE

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Nasal breathing disorders are associated with obstructive sleep apnea (OSA) syndrome and influence the availability of continuous positive airway pressure (CPAP) therapy. However, information is scarce about the impact of nasal resistance assessed by rhinomanometry on CPAP therapy. This study aimed to examine the relationship between CPAP adherence and nasal resistance evaluated by rhinomanometry, and to identify clinical findings that can affect adherence to CPAP therapy for patients with OSA. This study included 260 patients (199 men, 61 women; age 58 [interquartile ranges (IQR) 50–66] years) with a new diagnosis of OSA who underwent rhinomanometry (before, and 1 and 3 months after CPAP introduction) between January 2011 and December 2018. CPAP use was recorded, and the good and poor CPAP adherence groups at the time of patient registration were compared. Furthermore, those with improved and unimproved pre-CPAP high rhinomanometry values were also compared. Their apnea-hypopnea index (AHI) by polysomnography at diagnosis was 45.6 (IQR 33.7–61.6)/hour, but the residual respiratory event (estimated AHI) at enrollment was 2.5 (IQR 1.4–3.9)/hour and the usage time was 318 (IQR 226–397) minutes, indicating that CPAP was effective and adherence was good. CPAP adherence was negatively correlated with nasal resistance (r = -0.188, p = 0.002). The participants were divided into good (n = 153) and poor (n = 107) CPAP adherence groups. In the poor adherence group, rhinomanometry values before CPAP introduction were worse (inspiration, p = 0.003; expiration, p = 0.006). There was no significant difference in patient background when comparing those with improved (n = 16) and unimproved (n = 12) pre-CPAP high rhinomanometry values. However, CPAP usage time was significantly longer in the improved group 1 month (p = 0.002) and 3 months (p = 0.026) after CPAP introduction. The results suggest that nasal resistance evaluated by rhinomanometry is a useful predictor of CPAP adherence, and that improved rhinomanometry values may contribute to extending the duration of CPAP use.

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Demographics of Adults With Obstructive Sleep Apnea Who Undergo Nasal Surgery

Shah,

Darbinian,

Collazo

et al. 2024

OTO Open

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ObjectiveTo assess the demographic characteristics between adult obstructive sleep apnea (OSA) patients who did and did not undergo nasal surgery (NS).Study DesignRetrospective cohort study.SettingKaiser Permanente Northern California clinical database.MethodsRetrospective study of adult patients with ≥1 OSA diagnoses linked to clinical encounters from 2009 to 2016. Qualifying NS procedures performed on or after cohort entry through 2017 were ascertained. Demographic and clinical characteristics were compared; multivariable logistic regression examined associations of these characteristics with undergoing NS.ResultsA total of 174,821 patients had an OSA diagnosis. Among these, 3518 (2.0%) underwent NS, including septoplasty (61.9%), sinus‐related (12.9%), turbinate (14.2%), and rhinoplasty (11.1%) procedures. Compared to the nonsurgery group, NS patients were more likely to be male (75.5% vs 62.1%), younger (48.2 ± 13.0 vs 54.7 ± 14.1), have lower body mass index (31.8 ± 6.4 vs 34.3 ± 8.1), and no comorbid conditions (63.1% vs 53.5%), P < .001. After adjusting for sex, age, body mass index (BMI), neighborhood deprivation, and comorbidities, black and Asian/Pacific Islander adults with OSA had 42% and 46% decreased odds of undergoing NS compared with non‐Hispanic white patients (odds ratio, OR [95% confidence interval, CI]: 0.58 [0.50‐0.67] and 0.54 [0.49‐0.61]), while Hispanic patients had similar odds (OR [95% CI]: 1.02 [0.93‐1.12]). Patients living in neighborhoods of highest deprivation had 18% lower odds of undergoing NS, compared with patients from neighborhoods corresponding to areas of lowest deprivation (adjusted odds ratio [95% CI]: 0.82 [0.75‐0.91]).ConclusionThese findings suggest that younger age, male sex, lower BMI, and higher SES may be associated with a higher likelihood of undergoing NS in OSA patients.

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Topical nasal treatment efficacy on adult obstructive sleep apnea severity: a systematic review and meta‐analysis

Abstract: Conclusion TNTs may improve minimum oxygen saturation ODI RDI and subjective/quality-of-life measures Allergic patients may have more improvement in OSA measures compared with nonallergic patients Future studies are indicated to accurately determine the efficacy of TNTs

Cited by 7 publications

References 45 publications

Allergic Rhinitis

Allergic Rhinitis

The relationship between adherence to continuous positive airway pressure and nasal resistance measured by rhinomanometry in patients with obstructive sleep apnea syndrome

Demographics of Adults With Obstructive Sleep Apnea Who Undergo Nasal Surgery

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