The role of the nose in the pathogenesis of obstructive sleep apnea.
OBJECTIVE
To define the relationship between obstructive sleep apnea (OSA) and nasal obstruction, we have reviewed the literature on epidemiological, physiological, and randomized controlled studies in which the relationship between nasal obstruction and OSA was investigated.


RESULTS
Data from observational studies suggest that nasal obstruction contributes to the pathogenesis of OSA. Recently, studies have mainly focused on the effects of therapeutic interventions on the nose and OSA. Eleven trials with randomized controlled designs were found; external nasal dilators were used in five studies, topically applied steroids in one, nasal decongestants in three, and surgical treatment in two studies. Data from these studies showed only minor improvement in the symptoms and severity of OSA.


CONCLUSIONS
The current evidence suggests that the nose may not play a significant role in the pathogenesis of OSA. The impact of treating nasal obstruction in patients with OSA on long-term outcome remains to be defined more accurately through randomized controlled trials of medical and surgical therapies with large numbers of patients.
Kohler
Malcolm
M
Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland. Malcolm.Kohler@bluewin.ch
Bloch
Konrad E
KE
Stradling
John R
JR
D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D015508:Nasal Obstruction / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D016032:Randomized Controlled Trials as Topic; D015656:Respiratory Mechanics; D018570:Risk Assessment; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology*