A randomized, double-blind, placebo-controlled trial on the effect of intranasal corticosteroid as a treatment for moderate to severe obstructive sleep apnea with coexisting chronic rhinitis

Abstract

Background: Chronic rhinitis is a common co-existing disease and risk factor for obstructive sleep apnea(OSA). Current evidence on efficacy of intranasal steroid as a treatment in this population is scarce.

Methods: A prospective randomized, double-blind, placebo-controlled trial was conducted in patients with moderate to severe OSA with coexisting chronic rhinitis indicated by total nasal symptom score (TNSS) ≥ 6. We randomized the patients to receive intranasal fluticasone furoate, 110 mcg/day or placebo once daily for one-month duration. The primary end point was the change in apnea hypopnea index(AHI). The secondary end points included the changes in respiratory disturbance index(RDI), sleep architectures, TNSS and Thai version of the Pittsburgh sleep quality index(PSQI).

Results: A total of 26 patients were randomly assigned to receive intranasal steroid(N=14) and placebo(N=12). The adjusted percentage change of AHI and adjusted absolute difference change of AHI did not show significant difference between two groups 23% [95%CI; -25.8 to 72; p=0.33] and 11.6 events/hour [95%CI; -6.23 to 29.44; p=0.19]; respectively). Interestingly, significant reduction in non-supine RDI (59.03 events/hour [95% CI; 31.61 to 86.45; p=0.006]) and total time awake after sleep onset (19 minutes [95%CI; 1.26 to 37.57; p=0.037]) were observed in intranasal steroid group compared to placebo group.

Conclusions: The use of intranasal steroid improved continuity of sleep and may be considered in conjunction with supine position avoidance as alternative OSA treatment in this population.