Topical nasal steroid treatment does not improve CPAP compliance in unselected patients with OSAS.
BACKGROUND
Continuous positive airways pressure (CPAP) for treatment of obstructive sleep apnea (OSA) can produce troublesome nasal symptoms (i.e. congestion, rhinorrhea) that may reduce the compliance of CPAP. Topical nasal steroids are often prescribed to reduce these side effects, although scientific data are scarce supporting any benefits of this treatment for CPAP-induced nasal side effects.


OBJECTIVE
To study whether a topical nasal steroid can reduce CPAP-induced nasal symptoms and improve CPAP adherence during the initial phase of OSA treatment.


METHODS
A randomized, double-blinded, placebo-controlled study with fluticasone propionate 100 μg/nasal cavity twice daily Treatment was started 10 days prior to and continued throughout the first 4 weeks of CPAP. 63 patients who were selected for CPAP treatment participated. Nasal symptoms were recorded, nasal patency was assessed and lung function was measured with a peak flow meter. The patients' adherence to CPAP was recorded by the CPAP device.


RESULTS
Total nasal symptoms increased from baseline to 4 wks after CPAP use for both nasal treatments (p < 0.05). No differences in total nasal symptoms between treatments were seen (p = 1), and no differences in nasal peak flow values after treatment were seen (p = 0.11). Moreover, there were no differences in CPAP use between the treatments.


CONCLUSIONS
Fluticasone propionate as a nasal topical steroid does not reduce CPAP-induced unwanted nasal side effects, and has no beneficial effect on CPAP compliance during the first four weeks of treatment in unselected patients with OSAS.
Respiratory Medicine, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
Werner
W
Strobel
Manuel
M
Schlageter
Morgan
M
Andersson
David
D
Miedinger
Prashant N
PN
Chhajed
Michael
M
Tamm
Jörg D
JD
Leuppi
D000281:Administration, Intranasal; D000287:Administration, Topical; D000730:Androstadienes / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D000068298:Fluticasone; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome
D000730:Androstadienes; D000893:Anti-Inflammatory Agents; D000068298:Fluticasone