The Recumbent Position Affects Nasal Resistance: A Systematic Review and Meta‐Analysis

Abstract

Objective: Nasal diseases are among the main motives for the early discontinuation of continuous positive airway pressure therapy and for long-term therapeutic compliance with mandibular advancement device. Although our clinical experience leads us to the belief that recumbency impacts nasal airflow in some patient populations, there is no consensus regarding the magnitude of this effect and the specific group of patients who are the most affected by this condition. In this study, we conducted a meta-analysis to assess the effect of the recumbent position on nasal resistance and nasal airflow.Review Methods: PubMed (Medline), Cochrane Library, EMBASE, Scopus, and SciELO databases were checked for relevant studies by two members of the YO-IFOS study group. The two authors extracted the data. The main outcome was expressed as the difference between nasal resistance and nasal airflow before and after recumbency.Results: Nine studies with a total population of 291 individuals were included in the meta-analysis for nasal resistance after recumbency. We found a statistically significant difference in nasal airway resistance of −0.18 Pa sec/cm 3 as compared to before and after recumbency through rhinomanometry (RMM) analysis. A subgroup analysis revealed a variation of −0.20 Pa sec/cm 3 for patients with snoring or sleep apnea and − 0.10 Pa sec/cm 3 for healthy individuals. Regarding nasal airflow measured with RMM, three studies (n = 32) in asymptomatic controls revealed a statistically significant difference of 47.33 ml/sec.Conclusions: Recumbency increases nasal resistance and diminishes nasal airflow. This finding is of utmost importance in snorers and sleep apnea patients.

Validation of a Novel User Interface and Calculation Method For Determining Nasal Resistance And Patency

“…The review found studies discussing maxillary expansion as a primary treatment option to improve nasal breathing and target nasal resistance. The conclusions found positive aspects and improvement in nasal breathing from maxillary expansion, and oral appliances [20].…”

“…Key details included studies for normative measurement values and treatment indications listed in Appendix A. Three studies [24][25][26] discussed the analysis of peak flow inspiratory flow limitations and parameters, 3 evaluated pediatric and adult acoustic sound measurements with rhinometry [14][15][16], and 14 evaluated rhinomanometry and mean resistance parameters as a diagnostic tool for various treatment options to improve nasal breathing, nasal function, sleep, and overall quality of life [9- 14,[17][18][19][20][21][22][23]27,28 ]. Figure 1 shows a majority of the articles reviewed were published between 2016 and 2022 after the validation of 4-phase rhinomanometry and its increased recognition as a standard of care for measuring nasal function in 2015 [29][30] .…”

“…The association of skeletal growth and development were found to play a significant role in snoring and OSA compared to healthy children [23]. Novel approaches in the diagnosis of sleep and breathing disorders in adults and children presented a sensitivity and specificity as high as 96% [20]. This translates the device testing and data output as clinically comparable and compatible to the outcome of a diagnosis from a sleep study or the development of a diagnosis OSA prior to the initiation of a sleep study [11, 12, 18, 20, 21, and 23].…”

“…For more than 50 years, the treatments for breathing disorders and OSA have shown a relationship between nasal resistance, posture, and other potential factors that influence the changes in transnasal pressures against a specific pressure gradient, but do not discuss patient identification [20]. In 2020, Hsu et al found nasal resistance in a supine position at 150 Pascals was able to provide information on the optimal pap pressure required for tolerance [28].…”

Development and Validation of DAFNE: A Web Based Tool for Determining Airway Treatment Options for OSA and Nasal Breathing Disorders

“…The association of skeletal growth and development were found to play a significant role in snoring and OSA compared to healthy children [23]. The relevancy of these findings dictated the use of novel approaches used in the diagnosis of sleep and breathing disorders in adults and children and presented a [20]. This translates the device testing and data output as clinically comparable and compatible to the outcome of a diagnosis from a sleep study or the development of a diagnosis OSA prior to the initiation of a sleep study [11, 12, 18, 20, 21, and 23].…”