Outcomes and Implications of Nasal Measurements in Obstructive Sleep Apnea

Sammanfattning: BackgroundObstructive sleep apnea (OSA) is a prevalent disorder and symptoms of nasal obstruction are highly prevalent in OSA. Treatment of nasal obstruction in OSA patients has shown modest and variable outcomes in reducing the apnea hypopnea index (AHI), but significant improvements in other indicators, such as sleep quality and daytime sleepiness as well as reductions in arousals have been observed. We hypothesize that the nose plays a more prominent role in sleep-disordered breathing than previously recorded.MethodsThree prospective randomized case-control studies of OSA patients diagnosed through a type III sleep study. In study I, patients were examined with 4-phase rhinomanometry (4-PR) and for study II with 4-PR and acoustic rhinometry. The first two studies examined if these common objective methods for measuring nasal patency were associated with respiratory indices in sleep studies. The third study investigated if these differences were associated with a low arousal threshold endotype.ResultsOSA Patients with more hypopneas relative to apneas were more likely to have increased nasal resistance. Acoustic rhinometry measurements were significantly associated with 4-PR but not between the acoustic rhinometry and respiratory variables analyzed in the sleep studies. OSA patients with increased nasal resistance were associated with a low arousal threshold endotype.ConclusionsOSA patients demonstrating increased nasal resistance are associated with a low arousal endotype and display significant differences in respiratory disturbance during sleep compared to those with normal nasal resistance. This project has demonstrated suitable objective measures to detect these differences which has implications for the future stratification of OSA patients.