Dose response of continuous positive airway pressure on nasal symptoms, obstruction and inflammationin vivoandin vitro

Abstract

Obstructive sleep apnoea is a common condition associated with cardiovascular risk. Continuous positive airway pressure (CPAP) is an effective treatment but is associated with nasal side-effects, which hinder compliance and may result from inflammation.We investigated whether CPAP was pro-inflammatory to human subjects in vivo, and to cultured bronchial epithelial cells in vitro. In vivo, we further investigated whether induction of nasal inflammation was associated with the development of systemic inflammation, nasal symptoms and changes in nasal mucociliary clearance.In vitro, CPAP resulted in cytokine release from cultured BEAS-2B cells in a time-and dose (pressure)-dependent manner. In vivo, CPAP resulted in dose-dependent upregulation of nasal inflammatory markers associated with the development of nasal symptoms, and reduced mucociliary clearance. CPAP also upregulated selected markers of systemic inflammation.CPAP results in dose-dependent release of inflammatory cytokines from human epithelial cells in vitro and in vivo. In vivo responses were associated with systemic inflammation, reductions in nasal mucociliary function and the development of nasal symptoms. This emphasises the need for novel strategies to reduce nasal inflammation and therefore aid compliance.

Effect of Humidified Noninvasive Ventilation on the Development of Facial Skin Breakdown

“…These results supported previous research that reports a high prevalence of nasal symptoms after non-humidified CPAP. 45 In contrast, humidified CPAP was associated with less prevalence of nasal symptoms, which suggests that dryness of CPAP pressure increases the acute nasal symptoms after a period of 30 min. The discomfort score was partially increased with the non-humidified CPAP, and this finding was likely to be related to the high prevalence of nasal symptoms that was reported under the same condition.…”

Clinical side effects of continuous positive airway pressure in patients with obstructive sleep apnoea

“…Impairment of NMC can result in diseases of the upper airways like chronic rhinosinusitis . Several studies demonstrated that NMC is affected by using CPAP …”

“…inflammation) in a variety of cells and tissues . For example, some clinical and experimental studies have reported on local and systemic inflammatory responses with n‐CPAP . It has been specifically shown that n‐CPAP application can cause inflammation due to the mechanical stimulus on the nasal mucosa .…”

“…This could potentially result in sleep disturbance despite CPAP therapy. The dose–response effects of CPAP on airway and systemic inflammation, nasal symptoms and airway obstruction were investigated in CPAP‐naïve healthy individuals in vivo and in epithelial cell cultures in vitro . Findings from the in vitro component of the study showed that in response to CPAP, bronchial epithelial cells secrete cytokine IL‐6, and IL‐8, where IL‐6 is an important pro‐inflammatory cytokine and IL‐8 is a chemokine that attracts neutrophils to the site of inflammation.…”

Effect of humidified versus nonhumidified CPAP on inflammatory response and nasopharyngeal symptoms in healthy participants

“…It is the gold standard for management of clinically significant obstructive sleep apnea patients [1]. However, it has been reported to be associated with a high prevalence of local nasopharyngeal side effects such as increased neutrophil in the nasal mucosa [2,3], and it may induce upper airway inflammation [4]. It has been suggested that airway drying or direct distension of nasal mucosa are responsible of the nasopharyngeal inflammation.…”