Skip to main content

Advertisement

SpringerLink
Log in

Impact of Impaired Nasal Breathing on Sleep-Disordered Breathing

  • Review Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Objective: The role of the nose and its importance in the development and severity of sleep-disordered breathing (SDB) is still a matter of discussion. In the first part of this study, often-controversial data and theories about the nose are reviewed concerning its influence on the pathophysiology of SDB and to interpret certain clinical findings connected with impaired nasal breathing. In the second part, the effectiveness of some nonsurgical and surgical therapies is evaluated. Method: A worldwide literature research (Medline) was the basis for this review. Results: The study of the literature on nasal resistance and clinical findings about the effects of incomplete or complete nasal blockage, particularly in comparison of healthy persons and persons with SDB, allows the assumption of the existence of two different groups of responders: a larger group where the importance of the nose for SDB is negligible and a smaller group where the influence of the nose on SDB is crucial. The same seems to hold true for the responses to nonsurgical and surgical treatments with only a few surgical results available in the literature. While the success rate of nasal surgery for patients with obstructive sleep apnea, for instance, seems to be less than 20%, the normalization of nasal resistance often leads to a positive impact on the well-being and the sleep quality of these patients. However, because criteria to identify responders are lacking, the prediction of success of any treatment for the individual with SDB is not possible.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lemnious Levinus. The touchstone of complexions. London:1581

  2. Cline CL. The effects of intra-nasal obstruction on the general health. Med Surg Rep 1892;67:259–260

    Google Scholar 

  3. Wells WA. Some nervous and mental manifestations occurring in connection with nasal disease. Am J Med Sci 1898;116:677–692

    Google Scholar 

  4. Rundcrantz H. Postural variations of nasal patency. Acta Otolaryngol 1969;68:435–443

    Google Scholar 

  5. Hasegawa M, Saito Y. Postural variations in nasal resistance and symptomatology in allergic rhinitis. Acta Otolaryngol 1979;88:268–272

    Google Scholar 

  6. Desfonds P, Planès C, Fuhrman C, Foucher A, Raffestin B. Nasal resistance in snorers with or without sleep apnea: effect of posture and nasal ventilation with continuous positive airway pressure. Sleep 1998;21:625–632

    Google Scholar 

  7. De Vito A, Berrettini S, Carabelli A, et al. The importance of nasal resistance in obstructive sleep apnea syndrome: a study with positional rhinomanometry. Sleep Breath 2001;5:3–11

    Google Scholar 

  8. Lofaso F, Coste A, d’OrthoMP, et al. Nasal obstruction as a risk factor for sleep apnoea syndrome. Eur Respir J 2000;16:639–643

    Google Scholar 

  9. Hudgel DW, Robertson DW. Nasal resistance during wakefulness and sleep in normal man. Acta Otolaryngol 1984;98:130–135

    Google Scholar 

  10. Miljeteig H, Cole P, HaightSJ. Nasal resistance in recumbency and sleep. Rhinology 1995;33:82–83

    Google Scholar 

  11. Gluckman JL, Stegmeyer R. Nonallergic rhinitis. In: Paperella MM, ed. Otolaryngology. Philadelphia, PA: WB Saunders;; 1991:1892–1893

    Google Scholar 

  12. Feinsilver SH, Hertz G. Respiration during sleep in pregnancy. Clin Chest Med 1992;13:637–644

    Google Scholar 

  13. Proctor DF. The upper airways. I. Nasal physiology and defense of the lungs. Am Rev Respir Dis 1977;115:97–129

    Google Scholar 

  14. Scherer PW, Hahn II, Mozell MM. The biophysics of nasal airflow. Otolaryngol Clin N Amer 1989;22:265–278

    Google Scholar 

  15. Kuna ST, Remmers JE. Neural and anatomic factors related to upper airway occlusion during sleep. Med Clin North Am 1985;69:1221–1242

    Google Scholar 

  16. Butler J. The work of breathing through the nose. Clin Sci 1960;19:55–62

    Google Scholar 

  17. Heetderks DR. Observations on the reactions of normal nasal mucosa membrane. Am J Med Sci 1927;174:231–244

    Google Scholar 

  18. Olsen KD, Kern EB. Nasal influences on snoring and obstructive sleep apnea. Mayo Clin Proc 1990;65:1095–1105

    Google Scholar 

  19. James JE, de Burgh Daly M. Nasal reflexes. Proc Roy Soc Med 1969;62:1287–1293

    Google Scholar 

  20. Cole P, HaightJSJ. Posture and nasal patency. Am Rev Respir 1984;129:351–354

    Google Scholar 

  21. Cole P, HaightJSJ. Mechanisms of nasal obstruction during sleep. Laryngoscope 1984;94:1557–1559

    Google Scholar 

  22. Cassisi NJ, Biller HF, Ogura JH. Changes in arterial oxygen tension and pulmonary mechanics with the use of posterior packing in epistaxis: a preliminary report. Laryngoscope 1971;81:1261–1266

    Google Scholar 

  23. Cook TA, Komorn RM. Statistical analysis of the alterations of blood gases produced by nasal packing. Laryngoscope 1973;83:1802–1809

    Google Scholar 

  24. Cvetnic V, Cvetnic S, Grbac I. Temporary artificial obstruction of the nose and changes in gas exchange in the blood. Laryngoscope 1981;91:1001–1009

    Google Scholar 

  25. Hady MRA, Kodeira KZ, Nasef AH. The effect of nasal packing on arterial blood gases and acid-base balance and its clinical importance. J Laryngol Otol 1983;97:599–604

    Google Scholar 

  26. Zwillich CW, Pickett C, HansonFN, Weil JV. Disturbed sleep and prolonged apnea during nasal obstruction in normal men. Am Rev Respir Dis 1981;124:158–160

    Google Scholar 

  27. Olsen KD, Kern EB, Westbrook PR. Sleep and breathing disturbance secondary to nasal obstruction. Otolaryngol Head Neck Surg 1981;89:804–810

    Google Scholar 

  28. 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

    Google Scholar 

  29. Taasan V, Wynne JW, Cassisi N, BlockAJ. The effect of nasal packing on sleep-disordered breathing and nocturnal oxygen desaturation. Laryngoscope 1981;91:1163–1172

    Google Scholar 

  30. Johannessen N, Jensen PF, KristensenS, Juul A. Nasal packing and nocturnal oxygen desaturation. Acta Otolaryngol Suppl 1992;492:6–8

    Google Scholar 

  31. Tanaka Y, Honda Y. Nasal obstruction as a cause of reduced PCO2 and disordered breathing during sleep. J Appl Physiol 1989;67:970–972

    Google Scholar 

  32. Lavie P, RubinAE. Effects of nasal occlusion on respiration in sleep. Evidence of inheritability of sleep apnea proneness. Acta Otolaryngol 1984;97:127–130

    Google Scholar 

  33. Suratt PM, Turner BL, Wilhoit SC. Effect of intranasal obstruction on breathing during sleep. Chest 1986;90:324–329

    Google Scholar 

  34. Wetmore SJ, Scrima L, HillerFC. Sleep apnea in epistaxis patients treated with nasal packs. Otolaryngol Head Neck Surg 1988;98:596–599

    Google Scholar 

  35. Houston D, Williams AJ, FinbergS, Santiago S, Wald R. Disturbed sleep and prolonged apnea during nasal obstruction in normal men [letter]. Am Rev Respir Dis 1982;125:484–485

    Google Scholar 

  36. Wilhoit SC, Suratt PM. Effect of nasal obstruction on upper airway muscle activation in normal subjects. Chest 1987;92:1053–1055

    Google Scholar 

  37. Masing H, Horbaschk G. The influence of the nose on the sleeping habits of infants. Int Rhinol 1969;7:41–45

    Google Scholar 

  38. 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

    Google Scholar 

  39. Leznoff A, Haight JS, HoffsteinV. Reversible obstructive sleep apnea caused by occupational exposure to guar gum dust. Am Rev Respir Dis 1986;133:935–936

    Google Scholar 

  40. Lavie P, Gertner R, Zomer J, Podoshin L. Breathing disorders in sleep associated with “microarousals” in patients with allergic rhinitis. Acta Otolaryngol 1981;92:529–533

    Google Scholar 

  41. Rubinstein I. Nasal inflammation in patients with obstructive sleep apnea. Laryngoscope 1995;105:175–177

    Google Scholar 

  42. Houser SM, Mamikoglu B, Aquino BF, Moinuddin R, CoreyJP. Acoustic rhinometry findings in patients with mild sleep apnea. Otolaryngol Head Neck Surg 2002;126:475–480

    Google Scholar 

  43. Duchna HW, Rasche K, Orth M, Bauer T, Schultze-Werninghaus G. Anamnestic and polygraphic parameters in obstructive sleep apnea syndrome patients with reduced nasal respiration during the day in comparison with obstructive sleep apnea patients with normal nasal respiration [German]. Wien med Wschr 1996;146:348–349

    Google Scholar 

  44. Anch AM, Remmers JE, Bunce III H. Supraglottic airway resistance in normal subjects and patients with occlusive sleep apnea. J Appl Physiol 1982;53:1158–1163

    Google Scholar 

  45. Blakley BW, Mahowald MW. Nasal resistance and sleep apnea. Laryngoscope 1987;97:752–754

    Google Scholar 

  46. Young T, Finn L, Kim H. Nasal obstruction as a risk factor for sleep-disordered breathing. J Allergy Clin Immunol 1997;99 (suppl 2):S757–S762

    Google Scholar 

  47. Silvoniemi P, Suonpää J, Sipilä J, Grénman R, Erkinjuntti M. Sleep disorders in patients with severe nasal obstruction due to septal deviation. Acta Otolaryngol Suppl 1997;529:199–201

    Google Scholar 

  48. Atkins M, Taskar V, Clayton N, Stone P, Woodcock A. Nasal resistance in obstructive sleep apnea. Chest 1994;105:1133–1135

    Google Scholar 

  49. Fürst G, Riechelmann H, MannWJ, Amedee RG. Measurement of pharyngeal pressure in patients using nasal CPAP. Am J Rhinol 1995;9:353–356

    Google Scholar 

  50. Schechter GL, Ware J, Perlstrom J, McBrayerRH. Nasal patency and the effectiveness of nasal continuous positive air pressure in obstructive sleep apnea. Otolaryngol Head Neck Surg 1998;118:643–647

    Google Scholar 

  51. Miljeteig H, Hoffstein V, Cole P. The effect of unilateral and bilateral nasal obstruction on snoring and sleep apnea. Laryngoscope 1992;102:1150–1152

    Google Scholar 

  52. Miyazaki S, Itasaka Y, Ishikawa K, Togawa K. Acoustic analysis of snoring and the site of airway obstruction in sleep-related breathing disorders. Acta Otolaryngol 1998;(suppl 537):S47–S51

  53. Sauerland EK, Mitchell SP. Electromyographic activity of intrinsic and extrinsic muscles of the human tongue. Tex Rep Biol Med 1975;33:444–455

    Google Scholar 

  54. Gleeson K, Zwillich CW, Braier K, WhiteDP. Breathing route during sleep. Am Rev Respir Dis 1986;134:115–120

    Google Scholar 

  55. Konno A, Togawa K, Hoshino T. The effect of nasal obstruction in infancy and early childhood upon ventilation. Laryngoscope 1980;90:699–707

    Google Scholar 

  56. Ohki M, Usui N, Kanazawa H, Hara I, Kawano K. Relationship between oral breathing and nasal obstruction in patients with obstructive sleep apnea. Acta Otolaryngol Suppl 1996;523:228–230

    Google Scholar 

  57. Kratschmer F. About reflexes of the nasal mucosa on respiration and circulation [German]. Sitzungsber Akad Wiss Wien 1870;62:147–170

    Google Scholar 

  58. White DP, Cadieux RJ, Lombard RM, et al. The effects of nasal anesthesia on breathing during sleep. Am Rev Respir Dis 1985;132:972–975

    Google Scholar 

  59. McNicholas WT, Coffey M, McDonnell T, O’Regan R, FitzgeraldMX. Upper airway obstruction during sleep in normal subjects after selective topical oropharyngeal anesthesia. Am Rev Respir Dis 1987;135:1316–1319

    Google Scholar 

  60. Basner R, Ringler J, Garpestad E, et al. Upper airway anesthesia delays arousal from airway occlusion induced during human NREM sleep. J Appl Physiol 1992;73:642–648

    Google Scholar 

  61. Berry RB, Kouchi KG, Bower JL, Light RW. Effect of upper airway anesthesia on obstructive sleep apnea. Am J Respir Crit Care Med 1995;151:1857–1861

    Google Scholar 

  62. Strohl KP, Hensley MJ, Hallett M, Saunders NA, Ingram JrRH. Activation of upper airway muscles before onset of inspiration in normal humans. J Appl Physiol 1980;49:638–642

    Google Scholar 

  63. Rodgers G, ChanKH, Dahl RE. Antral choanal polyp presenting as obstructive sleep apnea syndrome. Arch Otolaryngol Head Neck Surg 1991;117:914–916

    Google Scholar 

  64. Duchna HW, Orth M, de Zeeuw J, et al. The impact of nasal obstruction on obstructive sleep apnea syndrome. Somnologie 2001;5:53–58

    Google Scholar 

  65. Kerr P, Millar T, Buckle P, Kryger M. The importance of nasal resistance in obstructive sleep apnea syndrome. J Otolaryngol 1992;21:189–195

    Google Scholar 

  66. Brouillette RT, Manoukian JJ, Ducharme FM, et al. Efficacy of fluticasone nasal spray for paediatric obstructive sleep apnea. J Pediatr 2001;138:838–844

    Google Scholar 

  67. Craig TJ, Teets S, Lehman EB, Chinchilli VM, ZwillichC. 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

    Google Scholar 

  68. Höijer U, Ejnell H, Hedner J, Petruson B, EngLB. The effects of nasal dilation on snoring and obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 1992;118:281–284

    Google Scholar 

  69. Metes A, Cole P, Hoffstein V, Miljeteig H. Nasal airway dilation and obstructed breathing in sleep. Laryngoscope 1992;102:1053–1055

    Google Scholar 

  70. Schönhofer B, Wenzel M, Barchfeld T, et al. Value of intra- and extraoral devices in the treatment of obstructive sleep apnea and snoring [German]. Med Klin 1997;92:167–174

    Google Scholar 

  71. Gosepath J, Amedee RG, Romantschuck S, MannWJ. Breathe Right nasal strips and the respiratory disturbance index in sleep related breathing disorders. Am J Rhinol 1999;13:385–389

    Google Scholar 

  72. Afzelius LE, Elmquist D, Hougaard K, et al. Sleep apnea syndrome—an alternative treatment to tracheotomy. Laryngoscope 1981;91:285–291

    Google Scholar 

  73. Nahmias JS, Karetzky MS. Treatment of the obstructive sleep apnea syndrome using a nasopharyngeal tube. Chest 1988;94:1142–1147

    Google Scholar 

  74. Masters IB, Chang AB, Harris M, O’NeilMC. Modified nasopharyngeal tube for upper airway obstruction. Arch Dis Child 1999;80:186–187

    Google Scholar 

  75. Woodhead CJ, Allen MB. Nasal surgery for snoring. Clin Otolaryngol 1994;19:41–44

    Google Scholar 

  76. Fairbanks DNF. Snoring: surgical vs nonsurgical management. Laryngoscope 1984;94:1188–1192

    Google Scholar 

  77. Low WK. Can snoring relief after nasal septal surgery be predicted?. Clin Otolaryngol 1994;19:142–144

    Google Scholar 

  78. Illum P. Septoplasty and compensatory inferior turbinate hypertrophy: long-term results after randomized turbinoplasty. Eur Arch Otorhinolaryngol 1997;254 (suppl 1):S89–S92

    Google Scholar 

  79. Heimer D, Scharf S, Liebermann A, et al. Sleep apnoea syndrome treated by repair of deviated nasal septum. Chest 1983;84:184–185

    Google Scholar 

  80. Simmons FB, Hill MW. Hypersomnia caused by upper airway obstruction. Ann Otol Rhinol Laryngol 1974;83:670–673

    Google Scholar 

  81. Dreher A, de la Chaux R, Grevers G, Kastenbauer E. Influence of nasal obstruction on sleep-associated breathing disorders [German]. Laryngorhinootologie 1999;78:313–317

    Google Scholar 

  82. Simmons FB, Guilleminault C, DementWC, et al. Surgical management of airway obstruction during sleep. Laryngoscope 1977;87:326–338

    Google Scholar 

  83. Rubin AHE, Eliaschar I, Joachim Z, Alroy G, Lavie P. Effects of nasal surgery and tonsillectomy on sleep apnea. Bull Eur Physiopathol Respir 1983;19:612–615

    Google Scholar 

  84. Dayal VS, Phillipson EA. Nasal surgery in the management of sleep apnea. Ann Otol Rhinol Laryngol 1985;94:550–554

    Google Scholar 

  85. Caldarelli DD, Cartwright R, LilieJK. Obstructive sleep apnea: variations in surgical management. Laryngoscope 1985;95:1070–1073

    Google Scholar 

  86. Aubert-Tulkens G, Hamoir M, van den Eeckhaut J, RodensteinDO. Failure of tonsil and nose surgery in adults with long-standing severe sleep apnea syndrome. Arch Intern Med 1989;149:2118–2121

    Google Scholar 

  87. Sériès 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(5 Pt 1):1261–1265

    Google Scholar 

  88. Sériès F, St Pierre S, Carrier G. Surgical correction of nasal obstruction in the treatment of mild sleep apnoea: importance of cephalometry in predicting outcome. Thorax 1993;48:360–363

    Google Scholar 

  89. Utley DS, Shin EJ, Clerk AA, Terris DJ. A cost-effective and rational surgical approach to patients with snoring, upper airway resistance syndrome, or obstructive sleep apnea syndrome. Laryngoscope 1997;107:726–734

    Google Scholar 

  90. Verse T, Pirsig W, KrokerBA. Obstructive sleep apnea and nasal polyps [German]. Laryngorhinootologie 1998;77:150–152

    Google Scholar 

  91. Friedman M, Tanyeri H, LimJW, et al. Effect of nasal breathing on obstructive sleep apnea. Otolaryngol Head Neck Surg 2000;122:71–74

    Google Scholar 

  92. Dagan Y. Rhinoplasty and sleep apnea syndrome. Somnologie 1997;1 (suppl 2):S49–S49

    Google Scholar 

  93. Lavie P, Zomer J, Eliaschar I, et al. Excessive daytime sleepiness and insomnia. Association with deviated nasal septum and nocturnal breathing disorders. Arch Otolaryngol 1982;108:373–377

    Google Scholar 

  94. Verse T, Maurer JT, PirsigW. Effect of nasal surgery on sleep-related breathing disorders. Laryngoscope 2002;112:64–68

    Google Scholar 

  95. Sher AE, Schechtman KB, Piccirillo JF. The efficiency of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep 1996;19:156–177

    CAS  PubMed  Google Scholar 

  96. Busaba NY. Same-stage nasal and palatopharyngeal surgery for obstructive sleep apnea: is it safe?. Otolaryngol Head Neck Surg 2002;126:399–403

    Google Scholar 

  97. Antila J, Sipilä J, Tshushima Y, et al. The effect of laser-uvulopalatopharyngoplasty on the nasal and nasopharyngeal volume measured with acoustic rhinometry. Acta Otolaryngol Suppl 1997;529:202–205

    Google Scholar 

  98. Welinder R, Cardell LO, UddmanR, Malm L. Reduced nasal airway resistance following uvulopalatopharyngoplasty. Rhinology 1997;35:16–18

    Google Scholar 

  99. Kawano K, Usui N, Kanazawa H, Hara I. Changes in nasal and oral respiratory resistance before and after uvulopalatopharyngoplasty. Acta Otolaryngol Suppl 1996;523:236–238

    Google Scholar 

  100. Mayer-Brix J, Mueller-Marschhausen U, Becker H, PeterJH. The incidence of pathological ENT findings in patients with clinically suspected obstructive sleep apnea syndrome [German]. HNO 1989;37:511–516

    Google Scholar 

  101. Williams AJ, Arand D, Yan-Go F, Clark G, Miller T. Adjuvant therapies for obstructive sleep apnea. Am Rev Respir Dis 1991;143:A590–A590

    Google Scholar 

  102. Ripberger R, Pirsig W. Long-term compliance with nasal CPAP treatment for obstructive sleep apnoea: prospective study in 50 patients [German]. Laryngorhinootologie 1994;73:581–585

    Google Scholar 

  103. Dorn M, Pirsig W, Verse T. Management of patients with severe obstructive sleep apnea following rhinosurgical interventions. A pilot study [German]. HNO 2001;49:642–645

    Google Scholar 

  104. Biermann E. Nasal CPAP therapy in obstructive sleep apnea syndrome: does functional rhinosurgery improve compliance [German]?. Somnologie 2001;5:59–64

    Google Scholar 

  105. Schäfer J. Spektralanalyse pathologischer schlafabhängiger Atemgeräusche der oberen Luftwege unter besonderer Berücksichtigung der Diagnostik und Therapie des obstruktiven Schlafapnoe-Syndroms und chronischer Rhonchopathien [thesis] Ulm, Germany: University of Ulm; 1990

  106. Hoffstein V, Mateika S, Metes A. Effect of nasal dilation on snoring and apneas during different stages of sleep. Sleep 1993;16:360–365

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University ENT Clinic Mannheim, Mannheim, Germany

    Thomas Verse M.D.

  2. ENT Department, University Hospital Ulm, Ulm, Germany

    Wolfgang Pirsig M.D.

Authors
  1. Thomas Verse M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wolfgang Pirsig M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thomas Verse M.D..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Verse, T., Pirsig, W. Impact of Impaired Nasal Breathing on Sleep-Disordered Breathing. Sleep Breath 7, 63–76 (2003). https://doi.org/10.1007/s11325-003-0063-2

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-003-0063-2

Keywords

Search

Navigation