Nasal function and CPAP use in patients with obstructive sleep apnoea: a systematic review

Area of Science:

• Otolaryngology
• Sleep Medicine
• Respiratory Medicine

Background:

• Nasal pathology is common in patients requiring positive airway pressure (PAP) therapy.
• Understanding the interplay between nasal conditions and PAP use is crucial for optimizing treatment adherence.
• Continuous positive airway pressure (CPAP) is a primary treatment for obstructive sleep apnea (OSA).

Purpose of the Study:

• To systematically review the impact of nasal pathology on CPAP use.
• To investigate the effects of CPAP on nasal structures and symptoms.
• To evaluate how treating nasal pathology influences CPAP adherence and efficacy.

Main Methods:

• A systematic literature search of PubMed and Scopus databases was performed up to October 2020.
• Sixty-three articles, predominantly observational studies, were selected for review.
• Studies were analyzed based on their relevance to nasal pathology, CPAP use, and treatment interventions.

Main Results:

• Larger nasal cross-sectional area and lower nasal resistance correlate with higher CPAP compliance and lower pressures.
• CPAP may increase nasal mucosal inflammation, but its effect on nasal symptoms is contradictory.
• Nasal surgery shows a clear benefit in improving CPAP compliance and reducing pressures; topical steroids have limited evidence.

Conclusions:

• A relationship exists between nasal anatomy/resistance and CPAP compliance.
• CPAP use may lead to increased nasal inflammation, while its impact on nasal patency is uncertain.
• Nasal surgery improves CPAP usage, but further research is needed on nasal symptoms and topical steroid efficacy.