Original ArticleRegular CPAP utilization reduces nasal inflammation assessed by nasal cytology in obstructive sleep apnea syndrome
Introduction
Multilevel anatomical obstruction contributes to the determinism of obstructive sleep apnea; in particular, even if conflicting results have been reported, several studies suggest that nasal obstruction contributes to its pathogenesis in many patients with obstructive sleep apnea syndrome (OSAS) [1], [2]. Nasal obstruction leads to mouth breathing, which is thought to destabilize the upper airway and to aggravate OSAS [3].
It is important to note that the nasal airways represent an important factor for the current treatment of OSAS by means of continuous positive air pressure (CPAP) ventilation during sleep. Therefore, nose pathology might represent an important factor influencing CPAP treatment in OSAS and there is preliminary evidence that subclinical nasal inflammation that cannot be identified from clinical assessment, nasal symptom scores, or rhinomanometry might be frequent and may be a factor influencing patients’ compliance to CPAP treatment [4].
The aim of this study was to analyze subclinical nasal inflammation in patients with OSAS by means of nasal cytology and to describe the changes induced by effective treatment by CPAP for a period of eight weeks.
Section snippets
Subjects
Thirty-two consecutive patients affected by OSAS (22 men and 10 women, mean age 46.9 ± 14.76 SD) and 13 control subjects (nine men and four women, mean age 49.1 ± 13.97 SD) were asked to participate in this study. Tobacco smoking was reported by five patients and two controls. The two groups showed no differences in age, sex ratio, or tobacco smoking.
Careful otorhinolaryngological history and examination was carried out in all subjects admitted to this study who also underwent inhalation prick test
History
A family history for atopia/allergies was found in seven (21.8%) patients. Almost all patients reported nasal symptoms coherent with a possible vasomotor condition: 15 (46.8%) reported nasal obstruction, 11 (34.3%) reported rhinorroea, five (15.6%) reported nasal itching, and 16 (50%) reported sneezing. Three (9.3%) patients also reported a reduction of the olfactory function.
Nasal endoscopy
Twelve out of the 32 OSAS patients (37.5%) showed non-obstructive deformities of the septal cartilage, 15 (46.8%) had
Discussion
Several studies have been carried out on the relationship between OSAS and inflammation of the upper airways [15], [16], [17]; others have searched for the eventual presence of predictive factors of the compliance to nasal CPAP treatment by means of the evaluation of the cytologic aspects, the modifications of certain mediators, and the degree of nasal obstruction, and also by rhinomanometry [4], [18], [19], [20].
The aim of this study was to analyze subclinical nasal inflammation in a group of
Financial disclosures of all authors
Raffaele Ferri has consulted for Merck & Co., Sanofi-Aventis, and Sapio Life; there are no financial interests that represent a potential conflict of interest for Matteo Gelardi, Giuseppe Carbonara, Enrico Maffezzoni, Maurizio Marvisi, or Nicola Quaranta.
Conflict of interest
The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated with this article can be viewed by clicking on the following link: doi: 10.1016/j.sleep.2012.04.004.
References (26)
- et al.
Nonallergic rhinitis with eosinophilia (NARES syndrome). Clinical and immunologic presentation
J Allergy Clin Immunol
(1981) - et al.
Airway inflammation in patients affected by obstructive sleep apnea syndrome
Respir Med
(2004) - et al.
High-resolution rhinomanometry, a new method to evaluate nasal patency in patients with allergic rhinitis
J Allergy Clin Immunol
(2003) - et al.
The eosinophil and the pathophysiology of asthma
J Allergy Clin Immunol
(1986) - et al.
The role of the nose in the pathogenesis of obstructive sleep apnoea and snoring
Eur Respir J
(2007) The role of the nose in snoring and obstructive sleep apnoea: an update
Eur Arch Otorhinolaryngol
(2011)The nose, snoring and obstructive sleep apnoea
Rhinology
(2011)- et al.
Nasal cytology: a marker of clinically silent inflammation in patients with obstructive sleep apnea and a predictor of noncompliance with nasal CPAP therapy
J Clin Sleep Med
(2005) International classification of sleep disorders: diagnostic and coding manual
(2005)- et al.
Skin tests used in type I allergy testing
Allergy
(1989)
Atlas of nasal cytology
Nasal cytology in clinical practice
Am J Rhinol
Nasal mastocytosis
J Allergy
Cited by (23)
Nasal cytology in children with primary snoring and obstructive sleep apnoea syndrome
2019, International Journal of Pediatric OtorhinolaryngologyCitation Excerpt :Zheng at al [21] reported an increased prevalence of NAR in adult patients with OSAS (29%) than in the general Chinese adult population (16.4%). Gelardi et al. [28] by means of the nasal cytology of 32 adult patients with OSAS showed that NAR was highly represented (59.3%). In particular, the most represented form was NARNE (28%), followed by NARES (19%) and NARESMA (13%).
Early effects of continuous positive airway pressure in a rodent model of allergic rhinitis
2016, Sleep MedicineCitation Excerpt :In our second hit model study, the addition of a second source of inflammation in a sequential way was not responsible for an additional increased inflammation measured by nasal cytology. This finding, which has been suggested previously [15], agrees with clinical reports showing no differences in CPAP compliance between non-allergic and allergic patients [12]. The process of AR includes a wide spectrum of interleukin (IL) release, including those with inhibitory actions [16].
Obstructive sleep apnea and perioperative complications: From mechanisms to risk modification
2013, Sleep Medicine ClinicsCitation Excerpt :This study showed that CRP decreased nonsignificantly in less than 3 months (Standard Mean Difference [SMD], 0.26, 95% confidence interval [CI] –0.08 to 0.60, P = .138), significantly decreased after 3 months (SMD, 0.68, 95% CI 0.34 to 1.02, P = .000), and further declined after 6 months (SMD, 0.74, 95% CI 0.43 to 1.05, P = .000) of CPAP treatment. Other studies describe a beneficial effect on pulmonary and nasal inflammatory markers but no effect on systemic markers.59,98 Treatment with CPAP is associated with a reduction of the oxidative stress marker, nitrotyrosine.59