Does nasal decongestion improve obstructive sleep apnea?

Clarenbach, Christian F.; Kohler, Malcolm; Senn, Oliver; Thurnheer, Robert; Bloch, Konrad E.

doi:10.1111/j.1365-2869.2008.00667.x

Cited by 56 publications

(61 citation statements)

References 17 publications

(28 reference statements)

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“…KIELY et al [7] investigated the effect of nasal corticosteroid in OSA patients with rhinitis and found a modest reduction of nasal resistance, which was positively correlated with a decrease in AHI. Lastly, CLARENBACH et al [13] applied once a nasal decongestant and measured nasal conductance continuously during sleep. The authors found reduced AHI during maximal nasal decongestion and thus suggested a pathophysiological link between nasal resistance and sleep disordered breathing.…”

Section: Discussionmentioning

confidence: 99%

“…The patients of the second group initially underwent 1 week of therapy with nasal placebo followed by 2 weeks of washout period and 1 week of therapy with nasal tramazoline and dexamethasone. A 2-week washout period between the 1-week regimens was employed because the time needed for the effect of medication to disappear is ,1 week [13,14]. The patients underwent four assessments, at the start and end of each treatment period.…”

Section: Protocolmentioning

confidence: 99%

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The effect of nasal tramazoline with dexamethasone in obstructive sleep apnoea patients

et al. 2013

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Although there is a strong correlation between oral/oro-nasal breathing and apnoea/ hypopnoea index in patients with obstructive sleep apnoea and normal nasal resistance at wakefulness, it remains unknown whether the pharmacological prevention of potential nasal obstruction during sleep could decrease oral/oro-nasal breathing and increase nasal breathing and subsequently decrease the apnoea/ hypopnoea index. This study evaluated the effect of a combination of a nasal decongestant with corticosteroid on breathing route pattern and apnoea/hypopnoea index.21 patients with obstructive sleep apnoea (mean apnoea/hypopnoea index 31.1 events per hour) and normal nasal resistance at wakefulness were enrolled in a randomised crossover trial of 1 weeks' treatment with nasal tramazoline and dexamethasone compared with 1 weeks' treatment with nasal placebo. At the start and end of each treatment period, patients underwent nasal resistance measurement and overnight polysomnography with attendant measurement of breathing route pattern.Nasal tramazoline with dexamethasone was associated with decrease in oral/oro-nasal breathing epochs and concomitant increase in nasal breathing epochs, and mean decrease of apnoea/hypopnoea index by 21%. The change in nasal breathing epochs was inversely related to the change in apnoea/hypopnoea index (R s 50.78; p,0.001).In conclusion, nasal tramazoline with dexamethasone in OSA patients with normal nasal resistance at wakefulness can restore the preponderance of nasal breathing epochs and modestly improve apnoea/ hypopnoea index. @ERSpublications Nasal tramazoline with dexamethasone in OSA patients can restore nasal breathing epochs and improve AHI modestly

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Section: Discussionmentioning

confidence: 99%

Section: Protocolmentioning

confidence: 99%

The effect of nasal tramazoline with dexamethasone in obstructive sleep apnoea patients

et al. 2013

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“…In a recently published randomised, placebo-controlled, crossover trial on the effects of intranasal xylometazoline (0.15 mg daily before bedtime) for 7 days, the authors found that, at reduced compared with placebo (27.3 vs 33.2) [61]. However, xylometazoline did not improve sleepiness assessed subjectively and objectively in this trial.…”

Section: Xylometazolinementioning

confidence: 56%

Pharmacological approaches to the treatment of obstructive sleep apnoea

Kohler

Bloch

Stradling

2009

Expert Opinion on Investigational Drugs

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ChooseBackground: Currently the treatment of choice for symptomatic obstructive sleep apnoea (OSA) is continuous positive airway pressure (CPAP). Some patients with OSA do not tolerate CPAP or have insufficiently severe symptoms to justify its use; for these patients, drug therapy would be a desirable potential therapeutic alternative. Objective: To summarize the current evidence on the effectiveness of drug therapy in patients with OSA. Methods: A systematic review of randomized controlled trials was performed to investigate the effects of drug therapy on OSA. Results/conclusions: Searches of bibliographical databases revealed 33 trials investigating the effects of 27 different drugs on OSA severity and/or symptoms. The mechanisms by which these drugs are supposed to improve OSA include, amongst others, an increase in tone of the upper airways, an increase in ventilatory drive, a reduction in airway resistance, and alterations in surface tension forces in the upper airway. In most of these studies there was no significant effect on OSA observed. However, there is evidence from a few small trials that some drugs, especially those thought to increase upper airway muscle tone, have the potential to reduce OSA severity; but further data from larger studies of adequate duration are needed.

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“…Nasal obstruction due to dry air at altitude might be a problem with this therapy. In OSA patients with coexistent chronic rhinitis, nasal decongestants (during an altitude sojourn of a few days) or topical steroids might be useful adjuncts that contribute to a better sleep quality and might also slightly improve OSA (Clarenbach et al, 2008;Kohler et al, 2009). …”

Section: Latshang and Blochmentioning

confidence: 99%

How to Treat Patients with Obstructive Sleep Apnea Syndrome during an Altitude Sojourn

Latshang

Bloch

2011

High Altitude Medicine & Biology

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Considering the high prevalence of the obstructive sleep apnea syndrome (OSA), it is expected that many patients with the disorder are traveling to altitude. However, this may expose them to the risk of pronounced hypoxemia, exacerbation of nocturnal breathing disturbances by frequent central apneas, impaired daytime performance, and high blood pressure. Recently, randomized studies specifically investigated the effects of altitude (1630-2590 m) in OSA patients and the optimal treatment in this setting.The results indicate that patients should continue to use continuous positive airway pressure therapy (CPAP) when sleeping at altitude. Since CPAP alone does not control central sleep apnea emerging at altitude, combined treatment with acetazolamide and CPAP should be considered, in particular, in patients with severe OSA and co-morbidities. Supplemental oxygen combined with CPAP might be advantageous in patients with OSA and concomitant cardiopulmonary disease by preventing hypoxemia and central sleep apnea. In patients unable to use CPAP or if electrical power is not available, an optimally fitted mandibular advancement device might be an alternative treatment option that can be combined with acetazolamide during altitude sojourns. Acetazolamide alone is also beneficial and better than no treatment at all, since it improves oxygen saturation, breathing disturbances, and the excessive blood pressure elevation in OSA patients traveling to altitude. , it is expected that many patients with the disorder are traveling to altitude. However, this may expose them to the risk of pronounced hypoxemia, exacerbation of nocturnal breathing disturbances by frequent central apneas, impaired daytime performance, and high blood pressure. Recently, randomized studies specifically investigated the effects of altitude (1630-2590 m) in OSA patients and the optimal treatment in this setting. The results indicate that patients should continue to use continuous positive airway pressure therapy (CPAP) when sleeping at altitude. Since CPAP alone does not control central sleep apnea emerging at altitude, combined treatment with acetazolamide and CPAP should be considered, in particular, in patients with severe OSA and co-morbidities. Supplemental oxygen combined with CPAP might be advantageous in patients with OSA and concomitant cardiopulmonary disease by preventing hypoxemia and central sleep apnea. In patients unable to use CPAP or if electrical power is not available, an optimally fitted mandibular advancement device might be an alternative treatment option that can be combined with acetazolamide during altitude sojourns. Acetazolamide alone is also beneficial and better than no treatment at all, since it improves oxygen saturation, breathing disturbances, and the excessive blood pressure elevation in OSA patients traveling to altitude.

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Does nasal decongestion improve obstructive sleep apnea?

Cited by 56 publications

References 17 publications

The effect of nasal tramazoline with dexamethasone in obstructive sleep apnoea patients

The effect of nasal tramazoline with dexamethasone in obstructive sleep apnoea patients

Pharmacological approaches to the treatment of obstructive sleep apnoea

How to Treat Patients with Obstructive Sleep Apnea Syndrome during an Altitude Sojourn

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