title: The effects of topical nasal steroids on continuous positive airway pressure compliance in patients with obstructive sleep apnea: a systematic review and meta-analysis.
abstract: OBJECTIVE
  The purpose of the study was to conduct a systematic review and meta-analysis in patients with obstructive sleep apnea (OSA), evaluating effects of topical nasal steroids on continuous positive airway pressure (CPAP) machine use and nasal symptoms.
  
  
  METHODS
  Data source: A comprehensive search of Pubmed, Scopus, Web of Science, and the Cochrane Library was performed through April 2016. Manual searches and subject matter expert input were also obtained. Studies assessing effects of nasal steroids on CPAP machine use in adults, which reported quantitative outcome data of CPAP compliance, were included.
  
  
  RESULTS
  Two studies (144 patients) met inclusion criteria. Both were randomized, placebo-controlled clinical trials (RCT). Pooled fixed effects analysis did not identify a statistically significant difference between both the groups for average duration of CPAP machine use per night. But there was an overall increase in the usage of 0.4 h (95 % confidence interval (CI) (-0.20, 1.00); P = 0.19) in favor of nasal steroids. Difference of percentage of nights with CPAP use was not demonstrated (mean difference 0.06, 95 % CI (-0.27, 0.39); P = 0.71). There was also no significant difference in nasal symptoms (mean difference 0.63, 95 % CI (-0.11, 1.36), P = 0.1).
  
  
  CONCLUSIONS
  Nasal steroids showed benefits on CPAP use, but did not reach statistical significance. Data was based on meta-analysis of RCTs of 4-week follow-up in unselected OSA patients. Future controlled studies with selected group and longer follow-up duration are needed to confirm the benefits of nasal steroid on CPAP compliance in OSA patients.
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. natamonc@gmail.com.|Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama4 Road Patumwan, Bangkok, 10330, Thailand. natamonc@gmail.com.
authors.forename: Natamon
authors.identifier: http://orcid.org/0000-0001-8589-4151
authors.initials: N
authors.lastname: Charakorn
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.|Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama4 Road Patumwan, Bangkok, 10330, Thailand.
authors.forename: Prakobkiat
authors.initials: P
authors.lastname: Hirunwiwatkul
authors.affiliation: Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama4 Road Patumwan, Bangkok, 10330, Thailand.|Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Naricha
authors.initials: N
authors.lastname: Chirakalwasan
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.|Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama4 Road Patumwan, Bangkok, 10330, Thailand.
authors.forename: Busarakum
authors.initials: B
authors.lastname: Chaitusaney
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand.
authors.forename: Mantana
authors.initials: M
authors.lastname: Prakassajjatham
mesh_terms: D000281:Administration, Intranasal; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects* / Q000523:psychology*; D005500:Follow-Up Studies; D006801:Humans; D010349:Patient Compliance / Q000523:psychology*; D016032:Randomized Controlled Trials as Topic; D020181:Sleep Apnea, Obstructive / Q000628:therapy*
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Continuous positive airway pressure; Nasal steroid; Obstructive sleep apnea; Sleep apnea syndromes