Reported nasal obstruction is associated with multiple sleep-related symptoms but shows only a modest association...

Nasal obstruction is frequently reported in patients evaluated for obstructive sleep apnea (OSA), but its contribution to disease severity and patient-reported symptoms remains incompletely understood.

To examine the associations between reported nasal obstruction categories, assessed using the Nasal Obstruction Symptom Evaluation (NOSE) score, apnea-hypopnea index (AHI), sleep parameters and patient-reported symptoms.

In this retrospective observational analysis of a prospective cohort, 4369 adults referred for sleep assessment with available baseline AHI data were included. Nasal obstruction was categorized as no reported obstruction, mild, moderate, or severe/extreme based on an initial screening question followed, when positive, by the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire. Associations between nasal obstruction categories, AHI, objective sleep parameters and patient-reported symptoms were assessed using multivariable regression models.

At baseline, 3602 patients (82.4%) had no reported nasal obstruction, whereas 767 patients (17.6%) reported nasal obstruction. Among patients with nasal obstruction, 210 (27.4%) had mild obstruction, 345 (45.0%) had moderate obstruction, and 212 (27.6%) had severe obstruction. Moderate and severe nasal obstruction categories were associated with higher adjusted AHI estimates compared with no reported nasal obstruction, although these associations were modest. In contrast, nasal obstruction categories were more consistently associated with patient-reported symptoms. Moderate and severe obstruction were associated with higher sleepiness, insomnia severity, asthenia, depressive symptoms, morning headaches, dyspnea, and memory complaints.

Reported nasal obstruction was associated with multiple patient-reported symptoms and, to a lesser extent, with higher adjusted AHI estimates among patients with moderate and severe nasal obstruction. These findings suggest that nasal obstruction should not be considered solely as a marker of objective OSA severity, but rather as a complementary clinical dimension capturing patient-perceived sleep-related impairment that is not fully reflected by AHI.