Intranasal corticosteroid therapy for obstructive sleep apnoea in patients with co-existing rhinitis.
BACKGROUND
Increased nasal airflow resistance (NAR) may contribute to the pathophysiology of obstructive sleep apnoea syndrome (OSAS) but studies investigating the effects of relieving nasal obstruction in OSAS have produced differing results. There are no reports of intranasal corticosteroid therapy in adult OSAS patients with reversible nasal obstruction.


METHODS
We evaluated an intranasal corticosteroid, fluticasone propionate, in 24 consecutive snorers with associated rhinitis using a randomised, placebo controlled, crossover design. Patients underwent polysomnography, snoring noise, and NAR measurements at baseline and after each 4 week treatment period.


RESULTS
Twenty three patients completed the protocol and were divided into an apnoeic group (group A; 13 patients) and a non-apnoeic snoring group (group S; 10 patients) based on an apnoea-hypopnoea frequency (AHI) of > or =10/h or <10/h. AHI was significantly lower following treatment with fluticasone than with placebo in the total population (median (quartile range) 11.9 (22.6) v 20 (26.3); p<0.05) and in group A (23.3 (21.3) v 30.3 (31.9); p<0.05). Median (95% confidence interval) within subject differences for AHI were -3.2 (-17.7 to -0.2) in the total population and -6.5 (-29.5 to 1.8) in group A. NAR was also lower on fluticasone (2.74 (1.21) v 3.27 (1.38), p<0.01), within subject difference being -0.45 (95% CI -0.87 to -0.21). The changes in AHI and NAR in group A were significantly correlated (r=0.56; p<0.05). Snoring noise and sleep quality were unchanged but daily diary records indicated subjective improvements in nasal congestion and daytime alertness with fluticasone (p<0.02).


CONCLUSIONS
Intranasal fluticasone is of benefit to some patients with OSAS and rhinitis. The data suggest that this form of nasal obstruction may contribute to the pathophysiology of OSAS.
Kiely
J L
JL
Department of Respiratory Medicine and the Respiratory Sleep Disorders Unit, St Vincent's University Hospital, Dublin, Ireland.
Nolan
P
P
McNicholas
W T
WT
D000281:Administration, Intranasal; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000336:Aerosols; D000403:Airway Resistance / Q000187:drug effects; D000730:Androstadienes / Q000008:administration & dosage*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D000068298:Fluticasone; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D012220:Rhinitis / Q000150:complications*; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000188:drug therapy*; D012913:Snoring / Q000150:complications / Q000188:drug therapy
D000305:Adrenal Cortex Hormones; D000336:Aerosols; D000730:Androstadienes; D001993:Bronchodilator Agents; D000068298:Fluticasone