Nasal obstruction and positional obstructive sleep apnea

Authors

  • Kornkla Panprapakorn Charoenkrung Pracharak Hospital, Bangkok, Thailand, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand andExcellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
  • Prakobkiat Hirunwiwatkul Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand and Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
  • Busarakum Chaitusaney Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand and Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
  • Natamon Charakorn Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand and Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand

Keywords:

Nasal obstruction, OSA, positional OSA, POSA

Abstract

Background: Nasal obstruction is one of common risk factors of obstruction in obstructive sleep apnea (OSA) which can be caused by structural abnormalities. Positional obstructive sleep apnea (POSA) is defined that severity of OSA will be worsen in supine position. However, the correlation between nasal obstruction and POSA are unclear.

Objectives: The aim of this study was to investigate the prevalence of nasal obstruction in OSA patients and find the correlation between nasal obstruction and respiratory disturbance index (RDI) in these subjects. We also aimed to determine find the correlations in OSA patients POSA and those without POSA.

Methods: This study was a descriptive study that collected data form medical records and polysomnography. A total of 340 OSA patients were recruited in the study. All of them underwent overnight polysomnography and nasal examination. We defined the severity of nasal obstruction (nasal septum deviation and inferior turbinate hypertrophy) for 4 grades: normal, mild, moderate and severe obstruction. Correlations between nasal obstruction and RDI were calculated.

Results: The prevalence of nasal obstruction in OSA patient was 77.6 %. Nasal obstruction was not correlated with severity of OSA in all parameters. RDI of 128 POSA patients was significantly correlation with nasal septum score (r = 0.196, P = 0.027) and total nasal obstruction score (r = 0.203, P = 0.022).

Conclusion: The prevalence of nasal obstruction in Thai OSA patients was high. Total nasal obstruction score and nasal septum deviation was found to be significantly correlated with the severity of POSA. Nasal examination is essential to identify nasal pathology and beneficial in OSA patients, especially POSA.

Downloads

Download data is not yet available.

References

Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 1999;22:667-89.

https://doi.org/10.1093/sleep/22.5.667

McNicholas WT. Diagnostic criteria for the sleep apnoea syndrome: time for consensus. Eur Respir J 1996;9:634-5.

https://doi.org/10.1183/09031936.96.09040634

Colish J, Walker JR, ElmayergiN, Almutairi S, Alharbi F, Lytwyn M, et al. Obstructive sleep apnea: effects of continuous positive airway pressure on cardiac remodeling as assessed by cardiac biomarkers, echocardiography, and cardiac MRI. Chest 2012;141:674-81.

https://doi.org/10.1378/chest.11-0615

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: S757-62. https://doi.org/10.1016/S0091-6749(97)70124-6

Egan KK, Kezirian EJ, Kim DW, Nasal obstruction and sleep-disordered breathing. Oper Tech Otolaryngol 2006;17:268-72.

https://doi.org/10.1016/j.otot.2006.10.004

Lee SH, Choi JH, Shin C, Lee HM, Kwon SY, Lee SH. How does open-mouth breathing influence upper airway anatomy? Laryngoscope 2007;117:1102-6. https://doi.org/10.1097/MLG.0b013e318042aef7

Douglas NJ, White DP, Weil JV, Zwillich CW. Effect of breathing route on ventilation and ventilatory drive. Respir Physiol 1983;51:209-18. https://doi.org/10.1016/0034-5687(83)90041-5

Teerapraipruk B, Chirakalwasan N, Simon R, Hirunwiwatkul P, Jaimchariyatam N, Desudchit T. Clinical and polysomnographic data of positional sleep apnea and its predictors. Sleep Breath 2012;16:1167-72. https://doi.org/10.1007/s11325-011-0627-5

Oksenberg A, Silverberg DS, Arons E, Radwan H. Positional vs nonpositional obstructive sleep apnea patients: anthropomorphic, nocturnal polysomnographic, and multiple sleep latency test data. Chest 1997;112:629-39. https://doi.org/10.1378/chest.112.3.629

Joosten SA, O'Driscoll DM, Berger PJ, Hamilton GS. Supine position related obstructive sleep apnea in adults: pathogenesis and treatment. Sleep Med Rev 2014;18:7-17. https://doi.org/10.1016/j.smrv.2013.01.005

De Vito A, Berrettini S, Carabelli A, Sellari-Franceschini S, Bonanni E, Gori S, et al. The importance of nasal resistance in obstructive sleep apnea syndrome: a study with positional rhinomanometry. Sleep Breath 2001;5:3-11. https://doi.org/10.1007/s11325-001-0003-y

Camacho M, Zaghi S, Certal V, Abdullatif J, Modi R, Sridhara S, et al. Predictors of Nasal Obstruction: Quantification and Assessment Using Multiple Grading Scales. Plast Surg Int 2016;2016:6945297. https://doi.org/10.1155/2016/6945297

Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 2009;5:263-76. https://doi.org/10.5664/jcsm.27497

Assanasen P, Banhiran W, Kositchaiwat N, Bunnag C. Prevalence of chronic rhinitis in Thai patients withobstructive sleep disordered breathing. J Med Assoc Thai 2013:96:1169-74.

Clark DW, Del Signore AG, Raithatha R, Senior BA. Nasal airway obstruction: Prevalence and anatomic contributors. Ear Nose Throat J 2018;97:173-6. https://doi.org/10.1177/014556131809700615

Fitzpatrick MF, Driver HS, Chatha N, Voduc N, Girard. Partitioning of inhaled ventilation between the nasal and oral routes during sleep in normal subjects. J Appl Physiol (1985) 2003;94:883-90. https://doi.org/10.1152/japplphysiol.00658.2002

Zonato AI, Bittencourt LR, Martinho FL, Júnior JFS, Gregório LC, Tufik S. Association of systematic head and neck physical examination with severity of obstructive sleep apnea-hypopnea syndrome. Laryngoscope 2003;113:973-80.

https://doi.org/10.1097/00005537-200306000-00011

Leitzen KP, Brietzke SE, Lindsay RW. Correlation between nasal anatomy and objective obstructive sleep apnea severity. Otolaryngol Head Neck Surg 2014; 150:325-31. https://doi.org/10.1177/0194599813515838

Rodrigues MM, Gabrielli MFR, Junior OAG, Filho VAP, Passeri LA. Nasal airway evaluation in obstructive sleep apnoea patients: volumetric tomography and endoscopic findings. Int J Oral Maxillofac Surg 2017;46:1284-90.https://doi.org/10.1016/j.ijom.2017.05.009

Miyazaki S, Itasaka Y, Ishikawa K, Togawa K. Influence of nasal obstruction on obstructive sleep apnea. Acta Otolaryngol Suppl 1998;537:43-6. https://doi.org/10.1080/00016489850182341

Georgalas C. The role of the nose in snoring and obstructive sleep apnoea: an update. Eur Arch Otorhinolaryngol 2011;268:1365-73.

https://doi.org/10.1007/s00405-010-1469-7

Hu B, Han D, Li Y, Ye J, Zang H, Wang T. Polysomnographic effect of nasal surgery on positional and non-positional obstructive sleep apnea/hypopnea patients. Acta Otolaryngol 2013;133:858-65. https://doi.org/10.3109/00016489.2013.782507

Downloads

Published

2023-07-17

How to Cite

1.
Panprapakorn K, Hirunwiwatkul P, Chaitusaney B, Charakorn N. Nasal obstruction and positional obstructive sleep apnea. Chula Med J [Internet]. 2023 Jul. 17 [cited 2024 May 20];66(2). Available from: https://he05.tci-thaijo.org/index.php/CMJ/article/view/78