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Does nasal decongestion improve obstructive sleep apnea?

Christian F Clarenbach¹, Malcolm Kohler, Oliver Senn

¹Pulmonary Division, University Hospital Zurich, Zurich, Switzerland.

Journal of Sleep Research

|August 20, 2008

Summary

Topical nasal decongestion improved nasal airflow in obstructive sleep apnea (OSA) patients. While the apnea-hypopnea index slightly decreased during peak effect, nasal decongestion did not significantly improve OSA severity or sleep quality.

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Area of Science:

Sleep Medicine
Otolaryngology
Respiratory Medicine

Background:

Obstructive sleep apnea syndrome (OSA) is a common disorder often accompanied by nasal congestion.
The relationship between nasal congestion and OSA severity remains controversial.
Topical nasal decongestants are frequently used to alleviate nasal obstruction.

Purpose of the Study:

To investigate the effect of topical nasal decongestion on obstructive sleep apnea severity.
To assess the impact of improved nasal airflow on polysomnographic parameters in OSA patients.
To determine if nasal decongestion provides clinically significant improvement in OSA.

Main Methods:

A randomized, placebo-controlled, cross-over trial was conducted.
Twelve OSA patients with chronic nasal congestion received nasal xylometazoline or placebo for one week each.
Polysomnography, including nasal conductance, OSLER test for vigilance, and symptom scores, were assessed.

Main Results:

Nasal xylometazoline significantly increased nocturnal nasal conductance compared to placebo.
The overall apnea-hypopnea index (AHI) did not differ significantly between xylometazoline and placebo treatments.
A slight, statistically significant reduction in AHI was observed 30-210 minutes after xylometazoline application, during its maximal effect.
Sleep quality, sleep resistance time, and subjective sleepiness (Epworth score) remained unchanged.

Conclusions:

Topical nasal decongestion with xylometazoline improves nasal airflow in OSA patients with nasal congestion.
A transient, mild reduction in AHI during maximal decongestion suggests a pathophysiological link between nasal congestion and OSA.
The decongestant effect was insufficient to achieve clinically meaningful improvements in OSA severity or sleep quality.