The Misunderstood Role of the Nose in Adult Sleep Disordered Breathing
Received Date: Sep 03, 2012 / Accepted Date: Sep 04, 2012 / Published Date: Sep 07, 2012
Sleep disordered breathing reflects a spectrum of disorders ranging from simple or habitual aesthetic snoring, to Obstructive Sleep Apnea (OSA) of varying severity. All of these entities result from increased upper airway resistance due to the summation of static and dynamic narrowing of any number of anatomical subsides in the upper aero digestive tract, including the nose, nasopharynx, retropalatal oropharynx, pharyngeal tonsil region, and retrolingual oropharynx
Sleep disordered breathing reflects a spectrum of disorders ranging from simple or habitual aesthetic snoring, to Obstructive Sleep Apnea (OSA) of varying severity. All of these entities result from increased upper airway resistance due to the summation of static and dynamic narrowing of any number of anatomical subsides in the upper aero digestive tract, including the nose, nasopharynx, retropalatal oropharynx, pharyngeal tonsil region, and retrolingual oropharynx. There is much misconception amongst primary care physicians and it lays public that the nasal airway is the central element in adults with OSA. Certainly, it is well accepted that nasopharyngeal obstruction in the form of adenoid hypertrophy is a significant contributing factor in children, and that removal of this obstruction is an effective means of remedy for obstructive sleep breathing . Still, it must be acknowledged that most data in this area examines the impact of adenotonsillar hypertrophy rather than adenoid hypertrophy alone, and consequently, adenotonsillectomy rather than adenoidectomy alone.
In adults, however, the physiologic contributions of nasal airflow to OSA-spectrum disorders are more questionable. This is somewhat counterintuitive because the nose does contribute approximately twothirds to total airway resistance . Nonetheless, data reveals that although nasal congestion may correlate with the symptom of snoring, there is no correlation with apnea hypopnea index , which is the primary metric of OSA. This issue was evaluated more quantitatively by other authors, who demonstrated that while there was some contribution of nasal resistance to the apnea hypopnea index, but it only accounted for 2.3% of the overall variance .
What is clear is that in patients with OSA who require continuous positive airway pressure, nasal obstruction is an important limiting factor in the success (tolerability) of this therapy . Furthermore, surgery to relieve nasal obstruction can significantly augment patients’ ability to utilize this modality of treatment . The role of nasal surgery in adult sleep disordered breathing should therefore be limited to a means to improve the symptom of snoring and to improve the tolerability of continuous positive airway pressure in those with OSA. Surgical relief of nasal obstruction has been shown to improve quality of life in those with snoring and OSA by augmenting daytime breathing and reducing fatigue . However, this may be similar to the effect of medical therapy, such as intranasal steroids, in management of chronic rhinitis.
- Ye J, Liu H, Zhang GH, Li P, Yang QT, et al. (2010) Outcome of adenotonsillectomy for obstructive sleep apnea syndrome in children. Ann Otol Rhinol Laryngol 119: 506-513.
- Ferris BG Jr, Mead J, Opie LH (1964) Partitioning of respiratory flow resistance in man. J Appl Physiol 19: 653-658.
- Young T, Finn L, Kim H (1997) Nasal obstruction as a risk factor for sleep-disordered breathing. The University of Wisconsin Sleep and Respiratory Research Group. J Allergy Clin Immunol 99: S757-S762.
- Lofaso F, Coste A, d'Ortho MP, Zerah-Lancner F, Delclaux C, et al. (2000) Nasal obstruction as a risk factor for sleep apnoea syndrome. Eur Respir J 16: 639-643.
- Hoffstein V, Viner S, Mateika S, Conway J (1992) Treatment of obstructive sleep apnea with nasal continuous positive airway pressure. Patient compliance, perception of benefits, and side effects. Am Rev Respir Dis 145: 841-845.
- Friedman M, Tanyeri H, Lim JW, Landsberg R, Vaidyanathan K, et al. (2000) Effect of improved nasal breathing on obstructive sleep apnea. Otolaryngol Head Neck Surg 122: 71-74.
- Li HY, Lin Y, Chen NH, Lee LA, Fang TJ, et al. (2008) Improvement in quality of life after nasal surgery alone for patients with obstructive sleep apnea and nasal obstruction. Arch Otolaryngol Head Neck Surg 134: 429-433.
Citation: Meen EK, Chandra R (2012) The Misunderstood Role of the Nose in Adult Sleep Disordered Breathing. Otolaryngology 2:e107. Doi: 10.4172/2161-119X.1000e107
Copyright: © 2012 Meen EK, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Select your language of interest to view the total content in your interested language
Share This Article
- Total views: 12194
- [From(publication date): 12-2012 - May 26, 2020]
- Breakdown by view type
- HTML page views: 8390
- PDF downloads: 3804