NARES: a risk factor for obstructive sleep apnea?
BACKGROUND
Nonallergic rhinitis with eosinophilia syndrome (NARES) constitutes a rare nasal condition characterized by a chronic, eosinophilic inflammation. Patients' major complaints constitute nasal congestion and rhinorrhea. Obstructive sleep apnea syndrome (OSAS) is a potentially life-threatening condition characterized by recurrent episodes of obstruction of the upper airways resulting in oxygen desaturation. Nasal congestion constitutes one predisposing factor for OSAS.


OBJECTIVE
The purpose was to study whether NARES constitutes a risk factor for OSAS.


METHODS
The study included 26 patients presenting typical symptoms of sleep apnea. Ten patients were diagnosed to suffer from NARES (mean age 56.8 +/- 12.5, body mass index [BMI] 29.3 kg/m(2) +/- 2.8; 9 men:1 woman) and were compared with 16 age- and BMI-matched individuals (mean age 58.8 +/- 11.6, BMI 29.7 kg/m(2) +/- 3.8, 16 men) without any nasal inflammation, such as allergic rhinitis, sinusitis, nasal polyposis, or vasomotor rhinitis. All patients were tested by polysomnography for an OSAS.


RESULTS
Patients suffering from NARES revealed significantly (P <.01) impaired polysomnographic parameters (hypopnea index, apnea-hypopnea index, mean and minimal oxygen saturation) compared with patients without any nasal inflammation.


CONCLUSIONS
Our data point to NARES as a risk factor for the induction or augmentation of OSAS. NARES patients suffered from severe OSAS, whereas nondiseased individuals suffered only from moderate OSAS, according to the criteria of the American Academy of Sleep Medicine. Our data support results of others, suggesting chronic nasal inflammation to cause OSAS. Mechanisms for our observations are not fully understood yet. Nasal obstruction or neuronal reflexes might be involved.
Kramer
Matthias F
MF
Department of Oto-Rhino-Laryngology/Head and Neck Surgery, Ludwig-Maximillians-University, Munich, Germany. mkramer@hno.med.uni-muenchen.de
de la Chaux
Richard
R
Fintelmann
Rose
R
Rasp
Gerd
G
D000368:Aged; D004802:Eosinophilia / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D012220:Rhinitis / Q000150:complications*; D025363:Rhinomanometry; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology / Q000209:etiology*; D013577:Syndrome