Topical nasal treatment efficacy on adult obstructive sleep apnea severity: a systematic review and meta-analysis

Nasal obstruction is a common complaint in patients with sleep-disordered breathing and obstructive sleep apnea (OSA). Although topical nasal treatments (TNTs) have been shown to reduce nasal resistance and improve nasal obstruction, there is conflicting evidence regarding the role of TNTs in adult OSA. In this systematic review and meta-analysis we aim to evaluate the role of TNTs in adults with OSA. Data sources used included PubMed, Ovid MEDLINE, and Cochrane Central, from January 2001 to July 2019.

Inclusion criteria were English-language studies containing original data on TNTs in adults (≥18 years) with OSA (apnea-hypopnea index [AHI] ≥5). Exclusion criteria were case reports, studies without outcome measures, and concurrent non-TNT treatment for OSA. Two investigators independently reviewed all articles and performed quality assessment using validated tools. Meta-analysis and quality assessment were performed.

Of the 2180 abstracts identified, 8 studies met inclusion criteria. TNTs included decongestants (4 of 8 studies), corticosteroids (3 of 8), and antihistamines (1 of 8). Outcome measures included AHI (8 of 8), respiratory distress index (RDI; 1 of 8), oxygen-desaturation index (ODI; 3 of 8), minimum SaO2 (MinSaO₂ ; 4 of 8), nasal resistance (4 of 8), endoscopic sinus surgery (4 of 8 studies) and standardized rhinoconjunctivitis quality of life questionnaire scores (1 of 8 studies). Qualitatively, all studies showed trends toward improving objective and subjective measures of OSA, although the significance of these improvements varied across studies. A meta-analysis was performed in 5 studies, but TNTs did not reveal a significant change in AHI (p > 0.05).

TNTs may improve minimum oxygen saturation, ODI, RDI, and subjective/quality-of-life measures. Allergic patients may have more improvement in OSA measures compared with nonallergic patients. Future studies are indicated to accurately determine the efficacy of TNTs.