title: Nasal involvement in obstructive sleep apnea syndrome.
abstract: Numerous studies have reported an association between nasal obstruction and obstructive sleep apnea syndrome (OSAS), but the precise nature of this relationship remains to be clarified. This paper aimed to summarize data and theories on the role of the nose in the pathophysiology of sleep apnea as well as to discuss the benefits of surgical and medical nasal treatments. A number of pathophysiological mechanisms can potentially explain the role of nasal pathology in OSAS. These include the Starling resistor model, the unstable oral airway, the nasal ventilatory reflex, and the role of nitric oxide (NO). Pharmacological treatment presents some beneficial effects on the frequency of respiratory events and sleep architecture. Nonetheless, objective data assessing snoring and daytime sleepiness are still necessary. Nasal surgery can improve the quality of life and snoring in a select group of patients with mild OSAS and septal deviation but is not an effective treatment for OSA as such. Despite the conflicting results in the literature, it is important that patients who are not perfectly adapted to CPAP are evaluated in detail, in order to identify whether there are obstructive factors that could be surgically corrected.
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Brasília University Hospital, HUB, SGAN 605, Avenida L2 Norte, 70830-200 Brasília, DF, Brazil.
authors.forename: Daniel de Sousa
authors.initials: Dde S
authors.lastname: Michels
authors.affiliation: Universidade de Brasília (UnB), Campus Universitário Darcy Ribeiro, 70910-900 Brasília, DF, Brazil.
authors.forename: Amanda da Mota Silveira
authors.initials: Ada M
authors.lastname: Rodrigues
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Brasília University Hospital, HUB, SGAN 605, Avenida L2 Norte, 70830-200 Brasília, DF, Brazil.
authors.forename: Márcio
authors.initials: M
authors.lastname: Nakanishi
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Brasília University Hospital, HUB, SGAN 605, Avenida L2 Norte, 70830-200 Brasília, DF, Brazil ; Universidade de Brasília (UnB), Campus Universitário Darcy Ribeiro, 70910-900 Brasília, DF, Brazil.
authors.forename: André Luiz Lopes
authors.initials: AL
authors.lastname: Sampaio
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Brasília University Hospital, HUB, SGAN 605, Avenida L2 Norte, 70830-200 Brasília, DF, Brazil ; Universidade de Brasília (UnB), Campus Universitário Darcy Ribeiro, 70910-900 Brasília, DF, Brazil.
authors.forename: Alessandra Ramos
authors.initials: AR
authors.lastname: Venosa