title: High nasal resistance is stable over time but poorly perceived in people with tetraplegia and obstructive sleep apnoea.
abstract: Obstructive sleep apnoea (OSA) is highly prevalent in people with tetraplegia. Nasal congestion, a risk factor for OSA, is common in people with tetraplegia. The purpose of this study was to quantify objective and perceived nasal resistance and its stability over four separate days in people with tetraplegia and OSA (n=8) compared to able-bodied controls (n=6). Awake nasal resistance was quantified using gold standard choanal pressure recordings (days 1 and 4) and anterior rhinomanometry (all visits). Nasal resistance (choanal pressure) was higher in people with tetraplegia versus controls (5.3[6.5] vs. 2.1[2.4] cmH2O/L/s, p=0.02) yet perceived nasal congestion (modified Borg score) was similar (0.5[1.8] vs. 0.5[2.0], p=0.8). Nasal resistance was stable over time in both groups (CV=0.23±0.09 vs. 0.16±0.08, p=0.2). These findings are consistent with autonomic dysfunction in tetraplegia and adaptation of perception to high nasal resistance. Nasal resistance may be an important therapeutic target for OSA in this population but self-assessment cannot reliably identify those most at risk.
authors.affiliation: Neuroscience Research Australia (NeuRA), Sydney, Australia. Electronic address: n.wijesuriya@neura.edu.au.
authors.forename: Nirupama S
authors.initials: NS
authors.lastname: Wijesuriya
authors.affiliation: Neuroscience Research Australia (NeuRA), Sydney, Australia; University of New South Wales, Sydney, Australia; Prince of Wales Hospital, Sydney, Australia.
authors.forename: Chaminda
authors.initials: C
authors.lastname: Lewis
authors.affiliation: Neuroscience Research Australia (NeuRA), Sydney, Australia; University of New South Wales, Sydney, Australia.
authors.forename: Jane E
authors.initials: JE
authors.lastname: Butler
authors.affiliation: Neuroscience Research Australia (NeuRA), Sydney, Australia; Prince of Wales Hospital, Sydney, Australia.
authors.forename: Bonsan B
authors.initials: BB
authors.lastname: Lee
authors.affiliation: University of Melbourne, Melbourne, Australia; Institute of Breathing and Sleep (IBAS), Melbourne, Australia.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Jordan
authors.affiliation: University of Melbourne, Melbourne, Australia; Institute of Breathing and Sleep (IBAS), Melbourne, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia.
authors.forename: David J
authors.initials: DJ
authors.lastname: Berlowitz
authors.affiliation: Neuroscience Research Australia (NeuRA), Sydney, Australia; University of New South Wales, Sydney, Australia.
authors.forename: Danny J
authors.initials: DJ
authors.lastname: Eckert
mesh_terms: D000328:Adult; D000368:Aged; D000403:Airway Resistance; D002574:Cervical Vertebrae; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000503:physiopathology; D010465:Perception; D011312:Pressure; D011782:Quadriplegia / Q000150:complications / Q000503:physiopathology* / Q000523:psychology*; D025363:Rhinomanometry; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000503:physiopathology* / Q000523:psychology*; D013119:Spinal Cord Injuries / Q000150:complications / Q000503:physiopathology / Q000523:psychology
keywords: Autonomic dysfunction; Nasal congestion; Sleep-disordered breathing; Spinal cord injury; Upper airway