Elsevier

Sleep Medicine

Volume 13, Issue 7, August 2012, Pages 859-863
Sleep Medicine

Original Article
Regular CPAP utilization reduces nasal inflammation assessed by nasal cytology in obstructive sleep apnea syndrome

https://doi.org/10.1016/j.sleep.2012.04.004Get rights and content

Abstract

Objectives

To analyze nasal inflammation in a group of patients with obstructive sleep apnea syndrome (OSAS) by means of nasal cytology and to describe the changes induced by continuous positive air pressure (CPAP) treatment.

Subjects and methods

Thirty-two consecutive patients affected by OSAS (mean age 46.9 years) and 13 control subjects (mean age 49.1 years) were enrolled. Detailed clinical, laboratory, and polysomnographic studies were obtained in all participants and, in particular, nasal cytology was performed; inflammatory cells (neutrophils, eosinophils, mast cells, lymphocytes), bacteria, and spores were counted. A subgroup of 19 OSAS patients underwent regular nasal CPAP for eight weeks while the remaining 13 were noncompliant. Nasal cytology was repeated after eight weeks in all patients and controls.

Results

All patients with OSAS were affected by some form of rhinopathy, mostly subclinical, which was not found to influence compliance to CPAP. Regular CPAP treatment induced a significant reduction of cell infiltration (neutrophils, eosinophils, lymphocytes, and muciparous cells), which was not seen in nontreated patients.

Conclusion

Nasal inflammation/infection is a very frequent finding in OSAS and can be reverted by the regular use of CPAP.

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.

. ICMJE Form for Disclosure of Potential Conflicts of Interest form.

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