Nasal obstruction as a risk factor for sleep-disordered breathing,☆☆,

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Abstract

Nasal obstruction frequently has been associated with sleep-disordered breathing as a potential etiologic factor. Nasal obstruction results in pathologic changes in airflow velocity and resistance. Experimentally produced nasal obstruction increases resistance and leads to sleep-disordered breathing events, including apnea, hypopnea, and snoring. Clinical research examining the correlation between nasal obstruction and sleep-disordered breathing is limited, especially in regard to patients with conditions that increase nasal resistance, such as rhinitis and sinusitis. To further identify risk factors for sleep-disordered breathing, the role of chronic and acute nasal congestion was investigated in a population-based sample. Data on nasal congestion history and sleep problems were obtained by questionnaire (n = 4927) and by objective in-laboratory measurement (n = 911). Participants who often or almost always experienced nighttime symptoms of rhinitis (5 or more nights a month) were significantly (p < 0.0001) more likely to report habitual snoring (3 to 7 nights a week), chronic excessive daytime sleepiness, or chronic nonrestorative sleep than were those who rarely or never had symptoms. Habitual snorers had significantly (p< 0.02) lower air flow than nonsnorers, although a linear relation between decreased airflow and sleep-disordered breathing severity did not exist. Participants who reported nasal congestion due to allergy were 1.8 times more likely to have moderate to severe sleep-disordered breathing than were those without nasal congestion due to allergy. Men and women with nasal obstruction, especially chronic nighttime symptoms of rhinitis, are significantly more likely to be habitual snorers, and a proportion also may have frequent episodes of apnea and hypopnea, indicative of severe sleep-disordered breathing. Because allergic rhinitis is a common cause of nasal obstruction and it is a modifiable risk factor, further study of this association is warranted. (J Allergy Clin Immunol 1997;99:S757-62.)

Section snippets

Methods

All men and women 30 to 60 years of age employed at one of five large state agencies in south central Wisconsin were surveyed about sociodemographic factors, sleep characteristics, brief medical history, and potential risk factors for sleep-disordered breathing. The job categories ranged from unskilled labor to professional at each agency. A total of 4927 questionnaires were completed, for a response rate of 75%. Of particular relevance to this investigation, questions were asked about the

Data analysis

Data were analyzed with software modules for descriptive statistics, contingency tables, multiple linear regression, and logistic regression. Mean airflow was adjusted for confounding factors, including age, sex, and BMI, by means of the general linear models procedure. Multiple regression modeling was used to estimate differences in AHI which may be due to nasal congestion and decreased airflow. For categorical outcome variables of hypersomnolence, snoring, and sleep-disordered breathing

Results

Characteristics of the survey sample (n = 4927) are shown in Table I and those of the cohort sample (n = 911) in Table II.

. Survey sample* characteristics (n = 4927)

CharacteristicFinding
Mean age (yr)45 (7.8)
Mean body mass index (kg/m2)29 (6.4)
Male (percentage of participants)59
Snoring status (percentage of participants)
 Occasional (1–3 nights per week)31
 Habitual (>3 nights per week)26
Allergies as cause of nasal congestion (percentage of participants)
 Medicate13
 Do not medicate22
 Total35
Rhinitis

Discussion

Indicators of nasal obstruction, including self-reported congestion and objectively measured flow, were associated with sleep-disordered breathing as evidenced by habitual snoring or worse sleep-disordered breathing. Although a linear trend between decreased nasal airflow and greater AHI was not observed, habitual snoring was consistently associated with decreased nasal airflow, self-reported stuffiness attributed to allergy, and self-reported nighttime nasal congestion or discharge. The lack

Conclusions

Sleep-disordered breathing, particularly simple snoring, which represents the mildest form, has a high prevalence among adults.18 Our analysis showed that in a population-based sample, middle-aged men and women with nasal obstruction, particularly those with chronic nighttime symptoms of rhinitis, are significantly more likely to be habitual snorers. A proportion of these patients also may have more severe sleep-disordered breathing with frequent episodes of apnea and hypopnea. The findings

References (21)

  • KD Olsen et al.

    Nasal influences on snoring and obstructive sleep apnea

    Mayo Clin Proc

    (1990)
  • RP Millman et al.

    Sleep, breathing and cephalometrics in older children and young adults. II: Response to nasal occlusion

    Chest

    (1996)
  • E Lugaresi et al.

    Snoring and sleep apnea: natural history of heavy snorers disease

  • EA Bresnitz et al.

    Epidemiology of sleep apnea

    Epidemiol Rev

    (1994)
  • P Lavie

    Nasal obstructions, sleep and mental function

    Sleep

    (1983)
  • MJ Papsidero

    The role of nasal obstruction in obstructive sleep apnea syndrome

    Ear Nose Throat J

    (1993)
  • DF Proctor

    The upper airways. Nasal physiology and defense of the lungs

    Am Rev Respir Dis

    (1977)
  • JW Shepard et al.

    Nasal and oral flow-volume loops in normal subjects and patients with obstructive sleep apnea

    Am Rev Respir Dis

    (1990)
  • M Wasicko et al.

    Nasal and pharyngeal resistance after topical mucosal vasoconstriction in normal humans

    Am Rev Respir Dis

    (1991)
  • DP White et al.

    The effects of nasal anesthesia on breathing during sleep

    Am Rev Respir Dis

    (1985)
There are more references available in the full text version of this article.

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From the Department of Preventive Medicine, University of Wisconsin aMari Palta, PhD, Jerome Dempsey, PhD, James Skatrud, MD, Safwan Badr, MD, Steven Weber, PhD, William Busse, MD, Anthony Jacques, MS, and Linda Evans.

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Reprint requests: Dr. Terry Young, Professor, Department of Preventive Medicine, University of Wisconsin, 504 North Walnut St., Madison, WI 53705

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