The nose and pharynx begin the upper airway system and represent a continuum. This is the biologic basis for the mutual influences of rhinitis and obstructive sleep apnea (OSA). Sleep-disordered breathing has a large differential diagnosis that includes snoring, upper airway resistance syndrome, and severe OSA. Nasal obstruction is an independent risk factor for OSA, but there is no correlation of daytime nasal resistance with the severity of OSA. However, nasal resistance was an independent predictor of apnea-hypopnea index in a recent study of nonobese OSA patients. Rhinitis alone is associated with mild OSA, but commonly causes microarousals and sleep fragmentation. Reduction of nasal inflammation with topical treatment improves sleep quality and subsequent daytime sleepiness and fatigue. Patient compliance with the nasal continuous positive airway pressure (nCPAP) device is relatively low, in part due to adverse nasal effects.
KeywordsObstructive Sleep Apnea Rhinitis Allergic Rhinitis Chronic Fatigue Syndrome Obstructive Sleep Apnea Syndrome
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References and Recommended Reading
- 10.Lofaso F, Coste A, d’Ortho MP, et al.: Nasal obstruction as a risk factor for sleep apnoea syndrome. Eur Respir J 2000, 16:639–643. First study that, by means of stepwise multiple regression analysis, showed that daytime nasal obstruction represents an independent risk factor for OSAS, even though it is weaker than cephalometric landmarks, obesity, and male sex.PubMedCrossRefGoogle Scholar
- 12.Chen W, Kushida CA: Nasal obstruction in sleep-disordered breathing. Otolaryngol Clin North Am 2003, 36:437–460. A comprehensive review of the relation between nasal obstruction and sleep disordered breathing—pathophysiology of SDB, link with nasal obstruction, causes of nasal obstruction, and therapeutic modalities. It includes 102 references.PubMedCrossRefGoogle Scholar
- 16.Qureshi A, Ballard RD, Nelson HS: Obstructive sleep apnea. J Allergy Clin Immunol 2003, 112:643–651. A comprehensive review of OSA that covers its pathophysiology, clinical features, clinical consequences, and therapeutic modalities. The authors suggested that the proinflammatory effect of OSA could be related to asthma severity.PubMedCrossRefGoogle Scholar
- 19.American Academy of Sleep Medicine: Sleep related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 1999, 22:667–689.Google Scholar
- 22.Guilleminault C, Chowdhuri S: Upper airway resistance syndrome is a distinct syndrome. Am J Respir Crit Care Med 2000, 161:1413–1416.Google Scholar
- 30.Remmers JE, de Groot WJ, Sauerland EK, et al.: Pathogenesis of upper airway occlusion during sleep. J Appl Physiol 1979, 46:931–938.Google Scholar
- 33.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
- 39.Duchna HW, Rasche K, Orth M, et al.: 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 Wochenschr 1996, 146:348–349.PubMedGoogle Scholar
- 40.Virkkula P, Hurmerinta K, Loytonen M, et al.: Postural cephalometric analysis and nasal resistance in sleep-disordered breathing. Laryngoscope 2003, 113:1166–1174. Must read. For the first time, the authors suggest that OSAS could be a complex disorder that could be subdivided into several subtypes with different contributing factors. By means of stepwise multiple regression analysis, they estimated that combined nasal resistance is an independent predictor of OSA severity.PubMedCrossRefGoogle Scholar
- 44.Martin SE, Wraith PK, Deary IJ, et al.: The effect of nonvisible sleep fragmentation on daytime function. Am J Resir Crit Care Med 1997, 155:1596–1601.Google Scholar