Nasal involvement in obstructive sleep apnea syndrome

Area of Science:

• Otolaryngology
• Sleep Medicine
• Respiratory Physiology

Background:

• Nasal obstruction is frequently associated with obstructive sleep apnea syndrome (OSAS).
• The exact pathophysiological mechanisms linking nasal issues to OSAS require further elucidation.
• Understanding this relationship is crucial for optimizing patient management.

Purpose of the Study:

• To review current data and theories on the nose's role in sleep apnea pathophysiology.
• To discuss the efficacy of medical and surgical nasal treatments for OSAS.
• To highlight areas needing further investigation.

Main Methods:

• Literature review and theoretical data synthesis.
• Analysis of pathophysiological mechanisms including the Starling resistor model, nasal ventilatory reflex, and nitric oxide.
• Evaluation of existing evidence on pharmacological and surgical interventions.

Main Results:

• Pharmacological treatments show potential benefits for respiratory event frequency and sleep architecture.
• Nasal surgery may improve quality of life and snoring in specific mild OSAS patients with septal deviation.
• Objective data on snoring and daytime sleepiness post-treatment are often lacking.

Conclusions:

• The precise role of nasal pathology in OSAS pathophysiology requires continued research.
• Medical therapies offer some advantages, but their impact on key OSAS symptoms needs more objective validation.
• Surgical correction of nasal obstruction may benefit select patients, particularly those with mild OSAS and septal deviation, and those poorly tolerating CPAP.