Effects of CPAP in patients with obstructive apnoea: is the presence of allergic rhinitis relevant?

Abstract

CPAP produces inflammation with increased nasal neutrophil levels in AR and nonAR patients. Nevertheless, patients with AR observed an improvement in nasal symptoms and quality of life, whereas in patients without AR, a relevant worsening of nasal dryness and mucociliary transport was observed.

Effect of continuous positive airway pressure on allergic rhinitis in patients with obstructive sleep apnea–hypopnea syndrome

“…Meanwhile, among the OSAHS patients with a history of AR, a significant increase in the exacerbation of rhinitis symptoms was observed during the second year of CPAP treatment. Similarly, Cisternas et al 6 observed an exacerbation of rhinitis symptoms in OSAHS patients without AR after two months of CPAP treatment, and no exacerbation of rhinitis symptoms has been observed in OSAHS patients with AR. The authors who reported the latter result proposed that a protective mechanism may exist in AR patients which prevents a second stimulation of the nose.…”

“…Previously published data regarding a relationship between CPAP and rhinitis have been inconsistent. For example, while most of the studies have revealed an infiltration of neutrophils into inflamed nasal mucous membrane following CPAP treatment of OSAHS patients, 6 not all of the studies have observed the same rhinitis symptoms. 5 , 6 , 13 , 14 These differences may be due to the methodologies used.…”

“…For example, while most of the studies have revealed an infiltration of neutrophils into inflamed nasal mucous membrane following CPAP treatment of OSAHS patients, 6 not all of the studies have observed the same rhinitis symptoms. 5 , 6 , 13 , 14 These differences may be due to the methodologies used. For the prospective studies that have been conducted, these have rarely extended over more than one year due to the difficulties associated with long-term follow-up studies.…”

“…Nasal symptom scores were recorded according to the following scale of nasal symptoms: 0 = no symptoms; 1 = mild symptoms (symptoms clearly present, but minimal awareness and easily tolerated); 2 = moderate symptoms (definite awareness of bothersome, yet tolerable, symptoms); and 3 = severe symptoms (hard-to-tolerate symptoms that interfered with daily living and/or sleeping activities). 6 , 9 …”

“…In a short-term study involving the application of CPAP with a nasal mask, both nasal inflammation and nasal symptoms were observed. 5 , 6 In other studies, concentrations of house dust mites (HDMs) were found to be related to the incidence of allergic disease symptoms, and in Guangzhou, People’s Republic of China, HDMs have been identified as the main allergen. 7 , 8 It is possible that continuous pressure injury due to CPAP can lead to damage to the junction of nasal mucous cells and the natural membrane barrier, thereby making affected individuals more sensitive to HDMs.…”