Frequency of Upper Airway Symptoms before and during Continuous Positive Airway Pressure Treatment in Patients with Obstructive Sleep Apnea Syndrome Effects of heated humidification and topical steroids on compliance, nasal symptoms, and quality of life in patients with obstructive sleep apnea syndrome using nasal continuous positive airway pressure. Development and validation of the Mini Rhinoconjunctivitis Quality of Life Questionnaire Topical nasal steroid treatment does not improve CPAP compliance in unselected patients with OSAS. Interventions to improve compliance in sleep apnea patients previously non-compliant with continuous positive airway pressure. Effect of heated humidification on compliance and quality of life in patients with sleep apnea using nasal continuous positive airway pressure. Clinical Control in the Dual Diagnosis of Obstructive Sleep Apnea Syndrome and Rhinitis: A Prospective Analysis
Background : Upper airway side effects are common during nasal continuous positive airway pressure ( nCPAP ) treatment and may affect the use of nCPAP . Objectives : It was our aim to evaluate the prevalence of upper airway symptoms in obstructive sleep apnea syndrome ( OSAS ) patients before and during  nCPAP treatment and to assess the possible association between the symptoms and long-term adherence to the treatment . Methods : We examined 385 consecutive OSAS patients ( 79 % men , mean age ± SD 52 ± 10 years and apnea-hypopnea index 33 ± 23 ) by means of a prospect i ve question naire-based survey . The patients filled in question naires about upper airway symptoms before starting nCPAP and after 2 months of treatment . Results : Upper airway symptoms were common before starting nCPAP : 61 % of the patients reported dryness of mouth , 54 % dryness of throat , 52 % nasal stuffiness , 51 % dryness of nose , 30 % sneezing , 24 % mucus in throat , 17 % rhinorrhea , and 6 % nose bleeds daily or almost daily . In  CPAP users there was a significant decline in the number of patients with frequent mouth ( 37 % ) , throat ( 34 % ) , nose ( 28 % ) dryness and nasal stuffiness ( 24 % ) . There was no difference in upper airway symptoms  before nCPAP treatment between those who continued the treatment after 1 year and those who terminated the treatment . Conclusions : The most common upper airway symptoms in patients with untreated OSAS seem to be associated with mucosal dryness . These symptoms improved during nCPAP treatment probably due to the change in breathing pattern . The occurrence of upper airway symptoms before nCPAP start did not predict long-term adherence to the treatment BACKGROUND Nasal side effects are common in patients with obstructive sleep apnea syndrome ( OSAS ) starting on nasal continuous positive airway pressure ( CPAP ) therapy . We tested the hypothesis that heated humidification or nasal topical steroids improve compliance , nasal side effects and quality of life in this patient group . METHODS 125 patients with the established diagnosis of OSAS ( apnea/hypopnea index > or = 10/h ) , who tolerated CPAP via a nasal mask , and who had a successful CPAP titration were r and omized to 4 weeks of dry CPAP , humidified CPAP or CPAP with additional topical nasal steroid application ( fluticasone , GlaxoWellcome ) . Groups were similar in all demographic variables and in frequency of nasal symptoms at baseline . Outcome measures were objective compliance , quality of life ( short form 36 ) , subjective sleepiness ( Epworth Sleepiness Scale score ) and nasal symptoms such as runny , dry or blocked nose , sneezing and headaches ; all variables assessed using a vali date d question naire and by direct interview . RESULTS There was no difference in compliance between groups after 4 weeks ( dry : 5.21 + /- 1.66 h/night , fluticasone : 5.66 + /- 1.68 , humidifier : 5.21 + /- 1.84 ; p = 0.444 ) . Quality of life and subjective sleepiness improved in all groups , but there were no differences in the extent of improvement . Nasal Symptoms were less frequently reported in the humidifier group ( 28 % ) than in the remaining groups ( dry : 70 % , fluticasone : 53 % , p = 0.002 ) . However , the addition of fluticasone result ed in increased frequency of sneezing . CONCLUSION The addition of a humidifier , but not nasal steroids decreases the frequency of nasal symptoms in unselected OSAS patients initiating CPAP therapy ; however compliance and quality of life remain unaltered The 28‐item  Rhinoconjunctivitis Quality of Life Question naire ( RQLQ ) has strong measurement properties but for large clinical trials , surveys and practice monitoring , where high efficiency is important , a shorter question naire is needed BACKGROUND Continuous positive airways pressure ( CPAP ) for treatment of obstructive sleep apnea ( OSA ) can produce troublesome nasal symptoms ( i.e. congestion , rhinorrhea ) that may reduce the compliance of CPAP . Topical nasal steroids are often prescribed to reduce these side effects , although scientific data are scarce supporting any benefits of this treatment for CPAP-induced nasal side effects . OBJECTIVE To study whether a topical nasal steroid can reduce CPAP-induced nasal symptoms and improve CPAP adherence during the initial phase of OSA treatment . METHODS A r and omized , double-blinded , placebo-controlled study with fluticasone propionate 100 μg/nasal cavity twice daily Treatment was started 10 days prior to and continued throughout the first 4 weeks of CPAP . 63 patients who were selected for CPAP treatment participated . Nasal symptoms were recorded , nasal patency was assessed and lung function was measured with a peak flow meter . The patients ' adherence to CPAP was recorded by the CPAP device . RESULTS Total nasal symptoms increased from baseline to 4 wks after CPAP use for both nasal treatments ( p < 0.05 ) . No differences in total nasal symptoms between treatments were seen ( p = 1 ) , and no differences in nasal peak flow values after treatment were seen ( p = 0.11 ) . Moreover , there were no differences in CPAP use between the treatments . CONCLUSION Fluticasone propionate as a nasal topical steroid does not reduce CPAP-induced unwanted nasal side effects , and has no beneficial effect on CPAP compliance during the first four weeks of treatment in unselected patients with OSAS STUDY OBJECTIVES Despite widespread agreement that continuous positive airway pressure is effective therapy for obstructive sleep apnea , it is estimated that 50 % of patients recommended for therapy are noncompliant 1 year later . Interventions to improve compliance in such patients have not been studied . We evaluated a 2 phase intervention program to improve compliance in  sleep apnea patients previously noncompliant with continuous positive airway pressure . METHODS 204 patients with previously diagnosed obstructive sleep apnea and noncompliant with continuous positive airway pressure were enrolled . Phase 1 evaluated st and ard interventions to improve therapy compliance  , including mask optimization , heated humidification , topical nasal therapy , and sleep apnea education . Persistently noncompliant patients proceeded to phase 2 , where compliance was compared in double-blind r and omized fashion between st and ard continuous positive airway pressure and flexible bilevel positive airway pressure . RESULTS 49 ( 24 % ) of 204 previously noncompliant patients became compliant ( average nightly use > or = 4 hours ) after st and ard interventions . Then 104 of the 155 persistently noncompliant patients agreed to continue and were r and omized to either CPAP or flexible bilevel positive airway pressure retitration and treatment for an additional ninety days . At follow-up 15 ( 28 % ) of the 53 r and omized to CPAP and 25 ( 49 % ) of the 51 r and omized to flexible bilevel positive airway pressure ( p = 0.03 ) achieved compliance . CONCLUSIONS A two phase intervention program , first employing st and ard interventions , followed by a change to flexible bilevel airway pressure , can achieve improved compliance in patients previously noncompliant with continuous positive airway pressure STUDY OBJECTIVE To determine whether the addition of heated humidification at treatment initiation with nasal continuous positive airway pressure ( CPAP ) would lead to better CPAP compliance and improve quality of life and subjective sleepiness in patients with sleep apnea . DESIGN R and omized controlled trial . SETTING An academic sleep center located at a Veterans Affairs hospital . PATIENTS Ninety-eight patients with obstructive sleep apnea who had not received nasal CPAP previously . MEASUREMENTS AND RESULTS Patients received heated humidification at CPAP initiation in the treatment group . In the control group , patients could receive heated humidification only if they had upper airway symptoms that could not be treated successfully with simpler measures . Patients were followed up at 1 month , 3 months , and 12 months . Outcome measures were compliance with nasal CPAP ( mean hours per night at effective pressure ) , quality of life as measured by the Calgary sleep apnea quality of life index , subjective sleepiness measured with the Epworth sleepiness scale , and CPAP side effects . There was no difference in CPAP compliance between groups . Quality of life and subjective sleepiness improved in both groups with nasal CPAP therapy , but there was no difference in the extent of improvement between groups . The overall CPAP side effect score was similar in both groups , but individual symptoms of dry nose and dry mouth and throat were significantly lower in the heated humidification group . CONCLUSIONS The addition of heated humidification when nasal CPAP was instituted did not lead to better compliance , greater improvement in sleepiness , or improved quality of life , but was associated with fewer symptoms attributable to the upper airway Background Obstructive sleep apnea syndrome ( OSAS ) and allergic rhinitis ( AR ) are common coexisting disorders . Upper airway , specifically al resistance , is thought to increase during exacerbations of AR and nonallergic rhinitis ( NAR ) , as well as in OSAS . The study objective was to determine if a correlation exists between clinical control of rhinitis and OSAS . Methods This prospect i ve study followed 43 patients with concurrent OSAS and AR or NAR . OSAS was diagnosed by polysomnography  , and AR or NAR was diagnosed by history , skin testing , serum-specific IgE , and total IgE levels . Measurements of control of OSAS included the Epworth Sleepiness Scale ( ESS ) survey and compliance with continuous positive airway pressure ( CPAP ) device . Measurements of rhinitis control included Assessment of Nasal Symptom Severity and Assessment of Nonnasal Symptom Severity ( NSS refers to both ) and Global Assessment of Nasal and Nonnasal Symptom Severity surveys ( GSS ) . Higher NSS scores correlate with more rhinitis symptoms , whereas higher GSS scores correlate with less symptoms . Results All patients completed the study . There was a positive correlation between ESS and NSS scores ( p < 0.001 ) , inverse correlation between ESS and GSS scores ( p < 0.001 ) , inverse correlation between CPAP compliance and NSS scores ( p < 0.001 ) , and positive correlation between CPAP compliance and GSS scores ( p < 0.001 ) . There was no statistically significant difference between the AR , NAR , and AR/NAR groups . Conclusion Our study showed a statistically significant positive correlation between clinical control of rhinitis symptoms and clinical control of OSAS . This study emphasizes the importance of achieving concurrent optimal control of both OSAS and AR/NAR
Objectives 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 .