Effects of heated humidification and topical steroids on compliance, nasal symptoms, and quality of life in patients with obstructive sleep apnea syndrome using nasal continuous positive airway pressure.
BACKGROUND
Nasal side effects are common in patients with obstructive sleep apnea syndrome (OSAS) starting on nasal continuous positive airway pressure (CPAP) therapy. We tested the hypothesis that heated humidification or nasal topical steroids improve compliance, nasal side effects and quality of life in this patient group.


METHODS
125 patients with the established diagnosis of OSAS (apnea/hypopnea index > or = 10/h), who tolerated CPAP via a nasal mask, and who had a successful CPAP titration were randomized to 4 weeks of dry CPAP, humidified CPAP or CPAP with additional topical nasal steroid application (fluticasone, GlaxoWellcome). Groups were similar in all demographic variables and in frequency of nasal symptoms at baseline. Outcome measures were objective compliance, quality of life (short form 36), subjective sleepiness (Epworth Sleepiness Scale score) and nasal symptoms such as runny, dry or blocked nose, sneezing and headaches; all variables assessed using a validated questionnaire and by direct interview.


RESULTS
There was no difference in compliance between groups after 4 weeks (dry: 5.21 +/- 1.66 h/night, fluticasone: 5.66 +/- 1.68, humidifier: 5.21 +/- 1.84; p = 0.444). Quality of life and subjective sleepiness improved in all groups, but there were no differences in the extent of improvement. Nasal Symptoms were less frequently reported in the humidifier group (28%) than in the remaining groups (dry: 70%, fluticasone: 53%, p = 0.002). However, the addition of fluticasone resulted in increased frequency of sneezing.


CONCLUSIONS
The addition of a humidifier, but not nasal steroids decreases the frequency of nasal symptoms in unselected OSAS patients initiating CPAP therapy; however compliance and quality of life remain unaltered.
Ryan
Silke
S
Sleep Research Laboratory, St. Vincent's University Hospital, Dublin, Ireland.
Doherty
Liam S
LS
Nolan
Geraldine M
GM
McNicholas
Walter T
WT
D000287:Administration, Topical; D000704:Analysis of Variance; D000730:Androstadienes / Q000008:administration & dosage / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005260:Female; D000068298:Fluticasone; D006358:Hot Temperature; D006801:Humans; D006813:Humidity; D008297:Male; D008875:Middle Aged; D015508:Nasal Obstruction / Q000517:prevention & control; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011788:Quality of Life; D012143:Respiratory Physiological Phenomena; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D011795:Surveys and Questionnaires
D000730:Androstadienes; D000893:Anti-Inflammatory Agents; D000068298:Fluticasone