Effect of nasal or oral breathing route on upper airway resistance during sleep Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men. A clinical trial of ipratropium bromide nasal spray in patients with perennial nonallergic rhinitis. The occurrence of sleep-disordered breathing among middle-aged adults. Effect of improved nasal breathing on obstructive sleep apnea External nasal dilation reduces snoring in chronic rhinitis patients: a randomized controlled trial. The effect of topical nasal fluticasone on objective sleep testing and the symptoms of rhinitis, sleep, and daytime somnolence in perennial allergic rhinitis. Disturbed sleep and prolonged apnea during nasal obstruction in normal men. Effect of treating severe nasal obstruction on the severity of obstructive sleep apnoea Effect of intranasal obstruction on breathing during sleep. Chronic nasal congestion at night is a risk factor for snoring in a population-based cohort study. The effects of nasal dilation on snoring and obstructive sleep apnea. The effect of ipratropium bromide on nasal hypersecretion induced by methacholine in patients with vasomotor rhinitis. A double-blind, cross-over, placebo-controlled and randomized dose-response study. Upper airway resistance syndrome: effect of nasal dilation, sleep stage, and sleep position. Snoring, apnea and nasal resistance in men and women. Adenotonsillectomy and obstructive sleep apnea in children: A prospective survey Nasal congestion secondary to allergic rhinitis as a cause of sleep disturbance and daytime fatigue and the response to topical nasal corticosteroids. Influence of posture and breathing route on neural drive to upper airway dilator muscles during exercise. Intranasal corticosteroid therapy for obstructive sleep apnoea in patients with co-existing rhinitis. Perennial rhinitis: An independent risk factor for asthma in nonatopic subjects: results from the European Community Respiratory Health Survey. Radiofrequency treatment of turbinate hypertrophy in subjects using continuous positive airway pressure: a randomized, double-blind, placebo-controlled clinical pilot trial. Efficacy of the topical nasal steroid budesonide on improving sleep and daytime somnolence in patients with perennial allergic rhinitis Snoring is not relieved by nasal surgery despite improvement in nasal resistance. Effect of nasal valve dilation on effective CPAP level in obstructive sleep apnea. How do topical nasal corticosteroids improve sleep and daytime somnolence in allergic rhinitis? Dichotomous Physiological Effects of Nocturnal External Nasal Dilation in Heavy Snorers: The Answer to a Rhinologic Controversy? Patient- and bed partner-reported symptoms, smoking, and nasal resistance in sleep-disordered breathing.
Healthy subjects with normal nasal resistance  breathe almost exclusively through the nose during sleep . This study tested the hypothesis that a mechanical advantage might explain this preponderance of  nasal over oral breathing  during sleep . A r and omised , single-blind , crossover design was used to compare upper airway resistance during sleep in the nasal and oral breathing conditions in 12 ( seven male ) healthy subjects with normal nasal resistance , aged 30±4 ( mean±sem ) yrs , and with a body mass index of 23±1 kg·m2 . During wakefulness , upper airway resistance was similar between the oral and nasal breathing routes . However , during sleep ( supine , stage two ) upper airway resistance was much higher while breathing orally ( median 12.4 cmH2O·L−1·s−1 , range 4.5–40.2 ) than nasally ( 5.2 cmH2O·L−1·s−1 , 1.7–10.8 ) . In addition , obstructive ( but not central ) apnoeas and hypopnoeas were profoundly more frequent when breathing orally ( apnoea-hypopnoea index 43±6 ) than nasally ( 1.5±0.5 ) . Upper airway resistance during sleep and the propensity to obstructive sleep apnoea are significantly lower while breathing nasally rather than orally . This mechanical advantage may explain the preponderance of nasal breathing during sleep in normal subjects One thous and and one men , aged 35 - 65 years , were identified from the age-sex register of one group general practice . Over four years 900 men were visited at home and asked questions about symptoms potentially related to sleep apnoea and snoring . Height , weight , neck circumference , resting arterial oxygen saturation ( SaO2 ) , and spirometric values were also determined . All  night oximetry  was then performed at home and the tracing analysed for the number of dips in SaO2 of more than 4 % . Subjects with more than five dips of 4 % SaO2 or more per hour were invited for sleep laboratory polysomnography .  Seventeen per cent of the men admitted to snoring " often . " Multiple linear regression techniques identified and ranked neck circumference ( r2 = 7.2 % ) , cigarette consumption ( r2 = 3.4 % ) , and nasal stuffiness ( r2 = 2 % ) as the only significant independent predictors of snoring . Together these account for at least a sixfold variation in the likelihood of being an " often " snorer . Forty six subjects ( 5 % ) had greater than 4 % SaO2 dip rates of over five an hour and 31 of these had full sleep studies . Three subjects had clinical ly obvious and severe symptomatic obstructive sleep apnoea , giving a prevalence of three per 1001 men ( 0.3 % ; 95 % confidence interval 0.07 - 0.9 % ) . Eighteen men had  obstructive sleep apnoea  only when supine and in 10 the cause of the SaO2 dipping on the original home tracing was not eluci date d. The greater than 4 % SaO2 dip rates correlated with the history of snoring . Multiple linear regression techniques identified and ranked neck circumference ( r2 = 7.9 % ) , alcohol consumption ( r2 = 3.7 % ) , age ( r2 = 1 % ) and obesity ( r2 = 1 % ) as the only significant independent predictors of the rate of overnight hypoxic dipping . This study shows that snoring in this r and omly selected population correlates best with neck size , smoking , and nasal stuffiness . Obstructive sleep apnoea , defined by nocturnal hypoxaemia , correlates best with neck size and alcohol , and less so with age and general obesity Intranasal ipratropium bromide has been shown to significantly reduce  rhinorrhea .  Use of a freon-propelled intranasal preparation has result ed in side effects associated with the drying properties of the propellant . The purpose of the present trial was to study the safety and efficacy of a new isotonic aqueous ipratropium bromide nasal spray pump , specifically in patients with perennial nonallergic rhinitis . Two hundred thirty-three patients participated in an 8-week double-blind parallel comparison of ipratropium bromide nasal spray with its vehicle , a saline solution . Treatment with the ipratropium spray result ed in a 30 % reduction in rhinorrhea ; this reduction was significantly greater than that seen with the saline vehicle . There was a modest reduction in postnasal drip , sneezing , and congestion with both treatments , which may be attributable to the salutary effects of the saline solution . Patients also perceived a significant reduction in the degree to which rhinorrhea interfered with their daily activities and moods . Treatment was well tolerated , with no drug-related systemic adverse events and no evidence of nasal rebound on discontinuation of treatment . Minor , infrequent episodes of nasal dryness and epistaxis were the only significant adverse events reported ; these did not limit treatment BACKGROUND Limited data have suggested that sleep-disordered breathing , a condition of repeated episodes of apnea and hypopnea during sleep , is prevalent among adults . Data from the Wisconsin Sleep Cohort Study , a longitudinal study of the natural history of cardiopulmonary disorders of sleep , were used to estimate the prevalence of undiagnosed sleep-disordered breathing among adults and address its importance to the public health . METHODS A r and om sample of 602 employed men and women 30 to 60 years old were studied by overnight polysomnography to determine the frequency of episodes of apnea and hypopnea per hour of sleep ( the apnea-hypopnea score ) . We measured the age- and sex-specific prevalence of sleep-disordered breathing in this group using three cutoff points for the apnea-hypopnea score ( > or = 5 , > or = 10 , and > or = 15 ) ; we used logistic regression to investigate risk factors . RESULTS The estimated prevalence of sleep-disordered breathing , defined as an apnea-hypopnea score of 5 or higher , was 9 percent for women and 24 percent for men . We estimated that 2 percent of women and 4 percent of men in the middle-aged work force meet the minimal diagnostic criteria for the sleep apnea syndrome ( an apnea-hypopnea score of 5 or higher and daytime hypersomnolence ) . Male sex and obesity were strongly associated with the presence of sleep-disordered breathing . Habitual snorers , both men and women , tended to have a higher prevalence of apnea-hypopnea scores of 15 or higher . CONCLUSIONS The prevalence of undiagnosed sleep-disordered breathing is high among men and is much higher than previously suspected among women . Undiagnosed sleep-disordered breathing is associated with daytime hypersomnolence OBJECTIVES The goal was to compare the effect of an improved nasal airway on obstructive sleep apnea ( OSA ) by use of subjective and objective measures . METHODS A prospect i ve study of 50 consecutive patients with nasal airway obstruction and OSA was carried out . RESULTS Subjectively , nasal breathing improved in 49 ( 98 % ) patients , whereas snoring decreased or disappeared in 17 ( 34 % ) ; the remaining 33 ( 66 % ) patients did not notice any significant change in their snoring . Daytime energy levels increased in 39 ( 78 % ) patients and remained unchanged or worsened in 11 ( 22 % ) . In review of the polysomno-graphic data , the group overall did not have significant changes in respiratory disturbance index ( RDI ) or lowest oxygen saturation levels ( LSaO2 ) . Continuous positive airway pressure ( CPAP ) levels required to correct OSA decreased after nasal surgery ( P < 0.01 ) . Patients with mild OSA showed significant worsening in RDI ( P < 0.05 ) , whereas LSaO2 levels were improved in the group with moderate OSA ( P < 0.05 ) . In patients with severe OSA neither the RDI levels nor the LSaO2 changed , but CPAP levels required to alleviate the obstruction after surgery were reduced ( P < 0.01 ) . CONCLUSIONS Most patients report improvement in nasal and sleep symptoms after correction of nasal airway obstruction . However , nasal surgery alone does not consistently improve OSA when measured objective ly . Depending on the severity of OSA , nasal airway reconstruction may contribute to a decrease in CPAP level and improvement in oxygen saturation . Correction of the obstructed nasal airway should certainly be included in the overall treatment plan for OSA . ( Otolaryngol Head Neck Surg 2000;122:71–4 . Chronic rhinitis patients often suffer from unrefreshing sleep and snoring , related to increased nasal resistance to airflow . Previous trials based on subjective assessment of snoring have demonstrated beneficial effects of Breathe Right ( BR ) , a noninvasive external nasal dilator . Polysomnography ( PSG ) was applied to objective ly assess the effects of BR on snoring . Twelve nonobese chronic rhinitis patients participated in the present study , which had a r and omized , placebo-controlled design . The presence of snoring and the absence of sleep apnoea was demonstrated during a baseline overnight sleep study . Patients were then r and omized for placebo or true nasal dilator treatment , which was also assessed by overnight PSG . The use of BR had no effect on sleep quality , arousal-index apnoea-hypopnoea-index or snoring loudness . Snoring frequency was significantly lowered by BR ( 173+/-29 snores x h(-l ) ) , compared with placebo ( 258+/-34 snores x h(-1 ) ; p=0.016 ) . The results support the hypothesis that Breathe Right is effective in reducing the amount of snoring in patients with chronic rhinitis . This objective finding is in line with some other reports on subjective improvement of snoring , based upon the judgement of bedpartners Recent data suggested that daytime somnolence in patients with allergic rhinitis was secondary to disrupted sleep caused by nasal congestion . Medications , which decreased congestion , would be expected to improve sleep and daytime somnolence . Previously , we showed that nasal steroids improved all three symptoms . Presently , we have not performed objective sleep testing to determine if there is a correlation between subjective improvement of congestion , sleep , and daytime somnolence . The objective of this 8-week , double-blind , placebo-controlled study was to determine if topical nasal fluticasone is effective at decreasing subjective congestion and daytime somnolence and improving sleep and if this improvement correlated with a change in overnight sleep testing ( polysomnography ) . We recruited 32 subjects with perennial allergic rhinitis and r and omized them in a double-blinded , cross-over fashion , to receive placebo or fluticasone ( 50 micrograms a spray ) , 2 sprays each side everyday , using Balaam 's design . Question naires , quality of life instruments , daily diary , Epworth Sleepiness Scale , and an overnight sleep test with polysomnograms were used as tools . The last 2 weeks of each 4-week treatment period were summarized , scored , and compared by PROC MIXED in SAS . Correlations between arousals on sleep tests and subjective tests were performed . Fluticasone improved subjective sleep when compared with placebo ( p = 0.04 ) ; however , there was no difference in the apnea/hypopnea index in those that were treated . Daytime sleepiness and fatigue were decreased by > 10 % in the treated group ; however , this was not statistically significant . However , fluticasone used at approved doses improves subjective sleep in patients with perennial allergic rhinitis without a change in the apnea/hypopnea index Anecdotal observations suggested that poor quality of sleep is a frequent complaint during upper respiratory infections ( URI ) . Nasal obstruction occurs frequently during URI and causes sleep apnea in some infants . Sleep apnea disrupts normal sleep and could explain the complaints of poor sleep quality during URI in adults . Accordingly , 10 normal men had full night recordings of sleep stages and breathing rhythm before and during nasal obstruction . The order of obstructed and nonobstructed nights was r and omized after a st and ard acclimatization night . During nasal obstruction , time spent in the deep sleep stages decreased from 90 + /- 11.2 ( SEM ) to 71 + /- 12.9 min ( p less than 0.05 ) , whereas significantly more time was spent in Stage 1 sleep ( p less than 0.03 ) . This loss of deep sleep during obstruction was associated with a twofold increase in sleep arousals and awakening ( p less than 0.01 ) result ing from an increased ( p less than 0.02 ) number of apneas ( 34 + /-19 during control sleep versus 86 + /- 34 during obstructed sleep ) . Apneas of 20 to 39 s in duration became 2.5 times more frequent ( p less than 0.05 ) during obstruction . Oxygen saturation was studied in the last 4 subjects using an ear oximeter .  Desaturation ( SaO2 less than 90 % ) occurred 27 times during control sleep compared with 255 times during obstructed sleep . These desaturation episodes occurred only during apneas . All men complained of poor sleep quality during nasal obstruction . We concluded that apneas , sleep arousals and awakenings , and loss of deep sleep occur during nasal obstruction and may explain complaints of poor sleep quality during URI An association between mouth breathing during sleep and increased propensity for upper airway collapse is well documented , but the effect of treatment for nasal obstruction on mouth breathing during sleep and simultaneous obstructive sleep apnoea ( OSA ) severity has not been described previously . A r and omised single blind placebo- and sham-controlled crossover study of treatment ( topical decongestant and external dilator strip ) for nasal obstruction was carried out in 10 patients ( nine males ; mean±sem 46±5 yrs ) with nasal obstruction and OSA . All patients had normal acoustic pharyngometry . The effect of treatment on nasal resistance , mouth breathing during sleep and OSA severity was quantified . Treatment of nasal obstruction was associated with a dramatic and sustained reduction in nasal resistance and the oral fraction of ventilation during sleep ( mean ( 95 % confidence interval ) absolute reduction in oral fraction 30 % ( 12–49 ) ) . Improvements in sleep architecture were observed during active treatment , and there was a modest reduction in OSA severity ( change in apnoea – hypopnoea index 12 ( 3–22 ) ) . In conclusion , treating nasal obstruction reduced mouth breathing during sleep and obstructive sleep apnoea severity , but did not effectively alleviate obstructive sleep apnoea While nasal mucosal stimulation in animals has been reported to produce central apneas and while nasal packing in humans is known to produce sleep-disordered breathing , it is controversial whether intranasal obstruction in humans produces predominantly central or obstructive apnea . To answer this question , we studied eight normal men by having them sleep in r and om order with their nose open or occluded with petrolatum gauze .  Esophageal pressure was measured to detect respiratory effort , and st and ard techniques were used to monitor and score the stages of sleep . Intranasal occlusion increased both the number of apneas plus hypopneas per hour of sleep and the minutes of obstructive events per hour of sleep ( p less than 0.05 ) . The minutes of central events per hour of sleep also increased significantly but not to the degree that occurred with obstructive events . Nasal obstruction produced no immediate changes in pulmonary function . The subject with the highest resistance measured through the mouth with the pulse flow method had the most apneas following nasal occlusion . We conclude that intranasal obstruction produces predominantly obstructive apneas and hypopneas during sleep BACKGROUND Nasal congestion at night is thought to have a role in snoring and sleep apnea , but this hypothesis has not previously been tested in a population -based study . METHODS Baseline and 5-year follow-up data on self-reported nocturnal nasal congestion and snoring frequency were collected from a population -based sample of 4916 men and women ( age range , 30 - 60 years at baseline ) enrolled in the ongoing Wisconsin Sleep Cohort Study .  In-laboratory polysomnography was performed on a subset ( n = 1032 ) of the study population to determine the frequency of apnea and hypopnea episodes during sleep . Logistic regression was used to estimate odds ratios for snoring with chronic nasal congestion at night . RESULTS Nocturnal nasal congestion frequency was independently associated with snoring frequency in cross-sectional analyses . The odds ratios ( adjusted for sex , age , body habitus , and smoking ) for habitual snoring with severe ( always or almost always ) nasal congestion vs none was 3.0 ( 95 % confidence interval , 2.2 - 4.0 ) . This association was not explained by habitual snorers with frank sleep apnea ( ie , > /=5 apnea and hypopnea episodes per hour of sleep ) . Prospect i ve analyses showed that persons with chronic severe nasal congestion had a high risk of habitual snoring according to the data from the 5-year follow-up survey : the odds ratio for habitual snoring and reporting congestion always or almost always at both baseline and follow-up was 4.9 ( 95 % confidence interval , 2.8 - 8.8 ) . CONCLUSIONS Nocturnal nasal congestion is a strong independent risk factor for habitual snoring , including snoring without frank sleep apnea . Intervention studies are needed to determine if snoring can be reduced with treatment of nasal congestion The effects of nasal valve dilation on snoring and obstructed breathing were studied in 11 patients with habitual snoring and /or obstructive sleep apnea . The anterior part of the nose , the valve region , was dilated by means of a plastic device .  Ten patients underwent polysomnographic investigation including pulse oximetry and measurement of snoring noise with and without the nasal dilator in a r and omized manner . Snoring , nocturnal arousals , and daytime hypersomnolence were rated by the patient and partner on a question naire before and after a 10-day treatment period with the dilator . The nasal airflow , as assessed by rhinomanometry when awake in the sitting position , increased by 18 % ( range , 5.5 % to 45 % ) when the nasal dilator was used . The frequency and severity of obstructed breathing decreased significantly with the nasal dilator . The apnea index with and without the nasal dilator was 6.4 ( range , 1.3 to 15 ) and 18 ( range , 1.8 to 60 ) , respectively . The mean decrease of the apnea index was 47 % . The overnight minimum arterial oxygen saturation ( with and without the nasal dilator was 84 % ( range , 76 % to 88 % ) and 78 % ( range , 68 % to 89 % ) , respectively . There was a substantial decrease in snoring noise ( number of epochs with Leq values , equal energy level , above 55 or 60 dB ) with the dilator in all patients who presented with snoring noise above these levels during the control night . No subjective effects on arousal frequency or daytime hypersomnolence were reported . Four of 11 patients were positive to continue using the nasal dilator The effect of various doses of ipratropium bromide aerosol on nasal hypersecretion induced by five concentrations methacholine was studied in 24 patients with vasomotor rhinitis and excessive watery nasal secretion . The volume of nasal secretion was greater with each of the five increasing doses of methacholine from 7.5 to 120 mg/ml . The median volume of nasal secretion was alike in all patients after administration of methacholine only and after treatment by placebo followed by methacholine . When the patients were treated with ipratropium bromide prior to administering methacholine the volume of secretion was reduced significantly . With doses of 40 micrograms and 100 micrograms of ipratropium to each nostril a similar reduction in the volume of secretion occurred but a still greater reduction by the application of 200 micrograms of ipratropium when compared with treatment by the placebo . While the volume of secretion increased with each increasing concentration of methacholine , a similar pattern of reduced secretion for each concentration of methacholine was seen with each greater concentration of ipratropium . In patients with vasomotor rhinitis , treatment with ipratropium bromide was found to reduce significantly the hypersecretion induced by methacholine when compared with treatment by the placebo . This reduction was greater with greater doses of ipratropium BACKGROUND The upper airway resistance syndrome ( UARS ) is one of the mild variants of obstructive sleep disordered breathing . Nasal obstruction is proposed as one of the mechanisms that lowers intrapharyngeal pressure and hence increases airway collapsibility . OBJECTIVE We evaluated the effect of external nasal dilation and sleep position on sleep in UARS . METHOD A double blind , r and omized , controlled study with a crossover design ( using therapeutic and placebo dilators ) was conducted in 18 consecutive patients with UARS . Each patient had two overnight sleep studies one to two weeks apart . Cardiorespiratory parameters ( AHI , percentage of time that SaO2 was more than 2 % below awake [ desaturation time ] and mean overnight heart rate ) , sleep architecture ( sleep stages , sleep efficiency , and arousal index ) , and body position were determined . RESULTS Application of the external nasal dilator result ed in a significant increase in the nasal cross-sectional area ( p < 0.001 ) . Treatment reduced stage 1 sleep ( as a percent of total sleep time ) from 8.6 + /- 0.8 % to 7.1 + /- 0.7 ( SEM ) , p = 0.034 ) . Desaturation time was significantly lower with treatment ( 12.2 + /- 2.2 % on placebo versus 9.1 + /- 1.3 on treatment , p = 0.04 ) . There were no additional significant effects on the cardiorespiratory parameters , sleep architecture , or MSLT when the entire night was examined . Controlling for interactions of sleep stage and position and treatment we found that treatment reduced desaturation time ( p = 0.03 ) but not AHI or arousal index . AHI was significantly lower in the lateral position compared to the supine ( p = 0.0001 ) and in NREM sleep compared to REM ( p = 0.001 ) . Desaturation time was significantly lower on the lateral compared to the supine position ( p = 0.002 ) and in NREM sleep compared to REM ( p = 0.006 ) . Arousal index was highly dependent on sleep stage ( p = 0.0001 ) : the index was higher in stage 2 compared to slow wave sleep and REM . Sleep position and treatment had no significant effect on arousals . CONCLUSIONS External nasal dilation reduced stage 1 sleep , an indirect marker of disrupted sleep , and desaturation time . There were no additional effects on sleep architecture or sleep disordered breathing . Both sleep position and sleep stage had a significant effect on sleep disordered breathing in UARS To examine if gender and airway resistance ( nasal and pulmonary ) influence the loudness and intensity of snoring , we prospect ively studied 370 unselected patients referred to our sleep clinic because of heavy snoring and a possibility of sleep apnea . All patients had full nocturnal polysomnography  , including measurements of snoring using a calibrated microphone-sound meter system , and determination of pulmonary ( Raw ) and nasal resistance ( Rna ) . Snoring was quantified by reporting the number of snores per hour of sleep ( snoring index -- SI ) and the maximum nocturnal sound intensity ( dBmax ) . The patient population comprised 77 females and 293 males , ranging in age from 12 to 80 years . Based on the apnea/hypopnea index ( AHI ) we separated all patients into the apneic and non-apneic groups . There were 201 non-apneic snorers ( AHI less than or equal to 10 ) and 160 apneic snorers ( AHI greater than 10 ) . There was no significant difference in snoring frequency , maximum nocturnal sound intensity , nasal and pulmonary resistance between men and women or between apneic and non-apneic snorers . Stepwise , forward , multiple linear regression analysis showed that body mass index and nasal resistance correlate significantly with the snoring index ( R2 = 0.29 , p less than 0.005 ) , while age and body mass index correlate only weakly , but significantly , with the maximum nocturnal sound intensity . We conclude that ( 1 ) men snore similarly to women , and ( 2 ) obesity and nasal resistance are important determinants of the frequency of snoring . It follows that measures taken to reduce weight and decrease nasal resistance may be of benefit in reducing snoring Objective Prospect i ve survey of children up to 14 years of age with OSA su bmi tted to adenotonsillectomy .  Methods Clinical evaluation , with question naires and clinical scales evaluating facial structures including tonsils and Mallampati scales and  otolaryngologic evaluation ; nocturnal polysomnography  and  repeat evaluation  three to five months postsurgery . Results Of 207 successively seen children , 199 had follow-up polysomnography , and 94 had still abnormal sleep recording . Multivariate analysis indicates that Mallampati scale score 3 and 4 , retro-position of m and ible , enlargement of nasal inferior turbinates at + 3 ( subjective scale 1 to 3 ) , and deviated septum were significantly associated with persistence of abnormal polysomnography ( with high 95 % CI for Mallampati scale and deviated septum ) . Conclusion Mallampati scale scores are result ant of several facial factors involving maxilla , m and ible , and oral versus oral breathing but add information on risk of partial response to adenotonsillectomy . Significance Adenotonsillectomy may not resolve obstructive sleep apnea in children BACKGROUND Allergic rhinitis ( AR ) is a frequent disease affecting up to 20 % of the population . AR causes a hypersensitivity reaction , which results in inflamed nasal mucosa and nasal congestion . Negative pressure generated during inspiration in the nasal airway secondary to nasal congestion may lead to nasal collapse , airway obstruction , and an increased number of sleep microarousals . Sleep disturbances and microarousals can detrimentally affect daytime energy levels , mood , and daytime function . It is unknown whether treatment directed to reduce congestion may reduce these microarousals , sleep problems , and , consequently , associated daytime fatigue . OBJECTIVE We sought to determine whether reducing nasal congestion with nasal steroids will reduce sleep complaints and daytime sleepiness . METHOD We enrolled 20 subjects in a double-blind , placebo-controlled study using Balaam 's Design . Patients were treated with topical nasal corticosteroids or placebo . Subjective data were collected by use of a daily diary , which focused on nasal symptoms , sleep , and daytime sleepiness . RESULTS The results demonstrated that nasal congestion and subjective sleep improved significantly in the topical corticosteroid-treated subjects but not in the placebo group . Sleepiness improved , but not significantly ( p = 0.08 ) . CONCLUSION Often , people with perennial allergies may attribute their daytime fatigue to causes such as the side effects of medications , when in fact , the fatigue may be a result of nasal congestion and associated sleep fragmentation . Decreasing nasal congestion with nasal steroids may improve sleep , daytime fatigue , and the quality of life of patients with AR Our purpose was to determine the influence of posture and breathing route on electromyographic ( EMG ) activities of nasal dilator ( NDM ) and genioglossus ( GG ) muscles during exercise . Nasal and oral airflow rates and EMG activities of the NDM and GG were recorded in 10 subjects at rest and during upright and supine incremental cycling exercise to exhaustion . EMG activities immediately before and after the switch from nasal to oronasal breathing were also determined for those subjects who demonstrated a clear switch point ( n = 7 ) . NDM and GG EMG activities were significantly correlated with increases in nasal , oral , and total ventilatory rates during exercise , and these relationships were not altered by posture . In both upright and supine exercise , NDM activity rose more sharply as a function of nasal inspired ventilation compared with total or oral inspired ventilation ( P < 0.01 ) , but GG activity showed no significant breathing-route dependence . Peak NDM integrated EMG activity decreased ( P = 0.008 ) , and peak GG integrated EMG activity increased ( P = 0.032 ) coincident with the switch from nasal to oronasal breathing . In conclusion , 1 ) neural drive to NDM and GG increases as a function of exercise intensity , but the increase is unaltered by posture ; 2 ) NDM activity is breathing-route dependent in steady-state exercise , but GG activity is not ; and 3 ) drive to both muscles changes significantly at the switch point , but the change in GG activity is more variable and is often transient . This suggests that factors other than the breathing route dominate drive to the GG soon after the initial changes in the configuration of the oronasal airway are made BACKGROUND Increased nasal airflow resistance ( NAR ) may contribute to the pathophysiology of obstructive sleep apnoea syndrome ( OSAS ) but studies investigating the effects of relieving nasal obstruction in OSAS have produced differing results . There are no reports of intranasal corticosteroid therapy in adult OSAS patients with reversible nasal obstruction . METHODS We evaluated an intranasal corticosteroid , fluticasone propionate , in 24 consecutive snorers with associated rhinitis using a r and omised , placebo controlled , crossover design . Patients underwent  polysomnography , snoring noise , and NAR measurements  at baseline and after each 4 week treatment period . RESULTS Twenty three patients completed the protocol and were divided into an apnoeic group ( group A ; 13 patients ) and a non-apnoeic snoring group ( group S ; 10 patients ) based on an apnoea-hypopnoea frequency ( AHI ) of > or = 10/h or < 10/h . AHI was significantly lower following treatment with fluticasone than with placebo in the total population ( median ( quartile range ) 11.9 ( 22.6 ) v 20 ( 26.3 ) ; p<0.05 ) and in group A ( 23.3 ( 21.3 ) v 30.3 ( 31.9 ) ; p<0.05 ) . Median ( 95 % confidence interval ) within subject differences for AHI were -3.2 ( -17.7 to -0.2 ) in the total population and -6.5 ( -29.5 to 1.8 ) in group A. NAR was also lower on fluticasone ( 2.74 ( 1.21 ) v 3.27 ( 1.38 ) , p<0.01 ) , within subject difference being -0.45 ( 95 % CI -0.87 to -0.21 ) . The changes in AHI and NAR in group A were significantly correlated ( r=0.56 ; p<0.05 ) . Snoring noise and sleep quality were unchanged but daily diary records indicated subjective improvements in nasal congestion and daytime alertness with fluticasone ( p<0.02 ) . CONCLUSIONS Intranasal fluticasone is of benefit to some patients with OSAS and rhinitis . The data suggest that this form of nasal obstruction may contribute to the pathophysiology of OSAS BACKGROUND Although clinical and experimental studies suggest that upper respiratory tract dysfunction may affect the lower airways , rhinitis is usually not studied as a potential risk factor for asthma . This is because both diseases share key elements of pathogenesis and are usually considered as different manifestations of the same underlying " atopic " state . OBJECTIVE We sought to assess whether asthma is associated with rhinitis in the absence of immunologic disorders in a population study . METHODS Data from 34 centers participating in the European Community Respiratory Health Survey were analyzed . R and om sample s of 20- to 44-year-old subjects were invited to complete a detailed question naire and undergo total and specific IgE measurements , skin prick tests to 9 allergens , and bronchoprovocation challenges with methacholine . RESULTS Subjects with perennial rhinitis ( n = 1412 ) were more likely than control subjects ( n = 5198 ) to have current asthma . After adjustment for sex , age , smoking habit , family history of asthma , geographic area , and season at the time of examination , asthma was strongly associated with rhinitis among atopic subjects ( odds ratio [ OR ] = 8.1 ; 95 % confidence interval [ CI ] = 5.4 - 12.1 ) but also among nonatopic subjects ( OR = 11.6 ; 95 % CI = 6.2 - 21.9 ) . Moreover , the association remained very strong when the analysis was restricted to nonatopic subjects with IgE levels of 80 kIU/L or less ( OR = 13.3 ; 95 % CI = 6 . 7 - 26.5 ) . In nonasthmatic subjects bronchial hyperresponsiveness was also more frequent in subjects with rhinitis than in those without rhinitis ( OR = 1.7 ; 95%CI = 1.2 - 2.6 in nonatopic subjects with IgE levels of < /=80 kIU/L ) . CONCLUSION The strong association between perennial rhinitis and asthma in nonatopic subjects with normal IgE levels is consistent with the hypothesis that rhinitis is an independent risk factor for asthma OBJECTIVES To estimate the treatment effect of temperature-controlled radiofrequency ( TCRF ) reduction of turbinate hypertrophy in patients with sleep-disordered breathing ( SDB ) treated with nasal continuous positive airway pressure ( CPAP )  , and to assess the impact of study design on this estimate . STUDY DESIGN Prospect i ve , r and omized , double-blind , placebo-controlled clinical pilot trial . METHODS Twenty-two CPAP-treated patients with SDB with turbinate hypertrophy were r and omly assigned to either TCRF turbinate treatment ( mean energy 415 + /- 37 J/turbinate ; n = 17 ) or placebo control ( n = 5 ) . Changes in nasal obstruction were evaluated between pretreatment and 4 weeks post-treatment . The primary outcome assessed changes in the blinded examiners ' findings of nasal obstruction on a visual analogue scale ( VAS ) . Secondary outcomes included blinded patients ' and unblinded examiner assessment s of nasal obstruction ( VAS ) , nightly CPAP use , adherence , and tolerance , along with sleepiness and general health status scales . The treatment group findings were subtracted from the changes in the placebo group to yield treatment effect . RESULTS The primary outcome treatment effect by VAS was -0.9 cm ( 95 % confidence interval [ CI ] , -2.4 , 0.7 ) , and beyond the placebo effect of -1.5 cm ( 95 % CI : -3.4 , 0.3 ) . The secondary treatment effect of the unblinded examiner was -3.0 cm ( 95 % CI , -4.9 , -1.1 ) . A beneficial treatment effect was also seen on every secondary outcome except general health status , but only self-reported CPAP adherence ( P = .03 ) was statistically significant . CONCLUSIONS TCRF turbinate treatment appears to benefit nasal obstruction and CPAP treatment for SDB . Placebo control and double blinding are critical for establishing the true treatment effect . A future definitive trial is feasible to establish statistical significance of these findings Background : Improving quality of life is considered to be a major endpoint and motivation for clinical intervention in patients with perennial allergic rhinitis ( PAR ) . In addition to classical symptoms of congestion , pruritus , and rhinorrhea , patients will often complain of not being able to sleep well at night and of feeling fatigued during the day . Like sleep apnea , PAR has also been shown to cause sleep disturbance and consequently worsen daytime fatigue and somnolence OBJECTIVES In the present study , we evaluated the effect of nasal surgery on  snoring time , snoring intensity , and sleep-disordered breathing .  The role of abnormal cephalometry in treatment outcome was assessed . DESIGN A cross-sectional prospect i ve study . SETTING University teaching hospital . PATIENTS Forty consecutive snoring men who were referred to ENT Hospital because of a snoring problem or suspicion of sleep apnea . INTERVENTIONS The patients underwent anterior rhinomanometry and polysomnography ( PSG ) with recording of snoring before and after operative treatment of nasal obstruction . Cephalometric radiographs were obtained before surgery . RESULTS Nasal resistance decreased significantly in the overall patient group . Snoring time , snoring intensity , nocturnal breathing , and sleep architecture did not change after nasal surgery . Cephalometry did not predict operative outcome in these patients . Snoring intensity was found to be significantly higher during non-rapid eye movement ( NREM ) sleep than during rapid eye movement sleep . CONCLUSIONS Operative treatment of mainly structural nasal obstruction did not seem to decrease snoring intensity , snoring time , or sleep-disordered breathing in an objective assessment by PSG performed after surgery . The effect of treating inflammatory nasal changes during nocturnal breathing , as well as the role of cephalometry in the prediction of treatment outcome will need further evaluation . Higher snoring intensity related to NREM sleep may add to the sleep disturbance of a bed partner in the evening Nasal problems are frequent at high continuous positive airway pressure ( CPAP ) . We hypothesized that a reduction of the nasal resistance reduces CPAP and investigated the effect of a nasal valve dilator ( Nozovent ) on CPAP in patients with obstructive sleep apnea . In a r and omized cross-over design Nozovent was inserted in 38 patients during one of two nights using AutoSet T. CPAP differences > 1 cm H2O were considered as clinical ly relevant . With Nozovent the median CPAP pressure was reduced from 8.6 cm H2O to 8.0 H2O ( P = 0.023 ) in all patients , but the number of patients with a reduction of CPAP by 1 cm H2O was not significant . The median CPAP level among 20 patients requiring a CPAP level of above 9 cm H2O was reduced from 10.3 to 9.1 cm H2O , P < 0.05 . A clinical improvement with Nozovent was seen in 10 of 20 patients requiring a pressure of above 9 cm H2O compared with 4 of 18 patients who needed lower pressures , P = 0.025 . Nozovent reduces the CPAP level 1 cm H2O in 50 % of patients requiring a high pressure ( > 9 cm H2O ) . Future studies should identify possible patients benefiting from a nasal dilator during CPAP therapy Therapy for rhinitis improves sleep quality and symptoms of daytime sleepiness . This improvement with therapy may be secondary to anti-inflammatory effects , leading to a reduction of inflammatory mediators , or to a mechanical reduction of congestion directly leading to improvement in sleep disturbance . We combined our data from 3 placebo-controlled studies of intranasal corticosteroids in patients with perennial rhinitis to determine whether a correlation between the reduction of congestion and improved sleep and daytime somnolence existed . The pooled data of budesonide , flunisolide , and fluticasone demonstrated significantly decreased nasal congestion , sleep problems , and sleepiness in treated patients . The data demonstrated a correlation between a reduction in nasal congestion and an improvement of sleep ( P < .01 ) and daytime somnolence ( P = .01 ) . Thus , topical intranasal corticosteroids should be used to decrease nasal congestion and to improve sleep and daytime somnolence in patients manifesting these symptoms The purpose of this article was to study the impact of external dilation on nasal airway dimensions , sleep architecture , and snoring .  Eighteen heavy snorers without severe obstructive sleep apnea syndrome ( mean apnea-hypopnea index ( AHI ) 9.3 ) reporting nocturnal nasal obstruction were enrolled in a r and omized ( controlled ) cross-over study , evaluating subjective and objective effects of external nasal dilation ( Breathe Right , 3 M ) . The active dilator was also worn during a one-week pretrial run-in period . Polysomnography , recording of snoring sounds , and repeated acoustic rhinometry were performed on two consecutive nights , one with the active dilator and one with a placebo strip . The significant subjective improvement reported during the run-in period compared to the preceding period without dilator ( p < 0.01 ) , remained only for nasal patency ( p < 0.05 ) when comparing the two nights in the sleep laboratory . The nasal dimensions increased significantly ( p < 0.001 ) with the active dilator compared to placebo , both in the evening and the next morning . In a subgroup ( n = 6 ) of habitual snorers ( AHI < 10 ) with severe morning obstruction ( combined minimal cross-sectional area < 0.6 cm2 ) , external dilation significantly improved the mean sleep PaSO2 ( 92.4 å 96.7 ) and the percentage of sleep with a PaSO2 < 95 % ( 49.9 % å 4.9 % ) ( p < 0.05 ) . In this subgroup there was a trend toward reduction in ( 7.4 å 5.4 ) ( p = 0.06 ) , whereas the AHI increased significantly in the group of 12 with larger nocturnal nasal dimensions ( p < 0.05 ) . Duration and intensity of snoring remained unchanged regardless of the subgrouping . Objective beneficial effects were restricted to nocturnal oxygen saturation and AHI in a subgroup of habitual heavy snorers identified by repeated acoustic rhinometry , in whom external dilation objective ly relieved marked nocturnal nasal obstruction . This finding may provide a logical explanation for the conflicting results of medical , surgical , and mechanical expansion of the nasal dimensions on snoring and sleep disturbances OBJECTIVES Nocturnal and daytime symptoms are important determinants in clinical decision making in patients suspected of having sleep-disordered breathing ( SDB ) . We compared patients ' and bed partners ' reporting of symptoms associated with SDB in a clinical sample of snoring men . The bed partners ' view on snoring disturbance was assessed . The relationship between sleep parameters , anthropometric data , and selected subjective symptoms was assessed . Additionally , we evaluated the relationship between smoking , nasal resistance , and habitual snoring . DESIGN A cross-sectional , prospect i ve study . SETTING University teaching hospital . PATIENTS Thirty-seven consecutive snoring men referred to ENT Hospital because of a snoring problem or suspicion of sleep apnea , and scheduled for surgical treatment of nasal obstruction . INTERVENTIONS The patients completed a sleep question naire , a question naire on nasal history , and the Epworth sleepiness scale .  The bed partners were asked to complete a separate sleep question naire of the patient 's daytime and nocturnal symptoms . Both patients and bed partners evaluated the intensity of snoring on a visual analog scale . The patients underwent  polysomnography and anterior rhinomanometry .  RESULTS Agreement of patients ' and bed partners ' reports on symptoms related to SDB was good in this material . One half of the bed partners were disturbed by snoring every night or almost every night , and one third of the bed partners reported disharmony in the relationship from time to time or repeatedly due to snoring . The combination of current smoking and total nasal resistance in a supine position higher than the median value in this patient sample was associated with history of habitual snoring . CONCLUSIONS Male patients and their bed partners seem to give congruent reports of snoring and symptoms related to SDB in a clinical population with mild SDB . One half of the bed partners found their sleep constantly disturbed . The combination of current smoking and high nasal resistance was related with habitual snoring
Data from observational studies suggest that nasal obstruction contributes to the pathogenesis of  snoring and obstructive sleep apnoea ( OSA ) .