Acoustic reflection for nasal airway measurement in patients with obstructive sleep apnea-hypopnea syndrome.
OBJECTIVE
To measure nasal dimensions and explore relationships between these and patients' use of continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS).


METHODS
Prospective single-blind study.


METHODS
A tertiary-care, sleep disorders referral center.


METHODS
Sixty OSAHS patients (52 men, mean age 51 years, body mass index (BMI) 36.1 +/- 9.4 kg/m2).


METHODS
After in-vitro validation, acoustic reflection was used to measure the nasal minimal cross-sectional area (MCSA), mean area, and volume in OSAHS patients receiving CPAP treatment. Variables from sleep studies included the apnea-hypopnea index (AHI), titration pressure, and CPAP use (hours per night) after 3 months. Median MCSA was used to categorize subjects into small and large MCSA groups. Correlation and regression analyses were conducted to investigate the relationship between results of polysomnography and nasal acoustic reflection.


RESULTS
At baseline the small and large MCSA groups were not different (P > .05) in BMI, age, mask type, or previous nasal stuffiness, but there were more women in the smaller MCSA group (P = .02). CPAP use was significantly lower in the small MCSA group (P = .007), but apnea-hypopnea index and titration pressure were indistinguishable between the 2 groups. Furthermore, CPAP use correlated significantly and positively with MCSA (r = 0.34, P = .008), mean area (r = 0.27, P = .04), and volume (r = 0.28, P = .03). Step-wise multiple regression models revealed that MCSA was a predictor of the CPAP compliance (R2 = 0.16, P = .002), and MCSA (P = .001) and age (P = .04) were predictive factors of CPAP compliance (R2= 0.22). Nasal dimensions were not related to subjective nasal stuffiness.


CONCLUSIONS
CPAP use in patients with smaller nasal passages was lower than in those with larger passages. Objective measurement of nasal dimension may be more reliable than subjective self-report of nasal symptoms in identifying patients with OSAHS who might struggle with CPAP therapy.
Li
Hsueh-Yu
HY
Department of Sleep Medicine, Royal Infirmary, Edinburgh, UK.
Engleman
Heather
H
Hsu
Chung-Yao
CY
Izci
Bilgay
B
Vennelle
Marjorie
M
Cross
Melanie
M
Douglas
Neil J
NJ
D000162:Acoustics / Q000295:instrumentation*; D000328:Adult; D000368:Aged; D045422:Continuous Positive Airway Pressure / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015508:Nasal Obstruction / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D017286:Polysomnography; D011446:Prospective Studies; D016037:Single-Blind Method; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy