Nasal inflammation in sleep apnoea patients using CPAP and effect of heated humidification

Abstract

Nasal continuous positive airway pressure (CPAP) can cause undesirable nasal symptoms, such as congestion to obstructive sleep apnoea (OSA) patients, whose symptoms can be attenuated by the addition of heated humidification. However, neither the nature of nasal symptoms nor the effect of heated humidification on nasal pathophysiology and pathology are convincingly known.20 patients with OSA on nasal CPAP who exhibited symptomatic nasal obstruction were randomised to receive either 3 weeks of CPAP treatment with heated humidification or 3 weeks of CPAP treatment with sham-heated humidification, followed by 3 weeks of the opposite treatment, respectively. Nasal symptom score, nasal resistance, nasal lavage interleukin-6, interleukin-12 and tumour necrosis factor-a and nasal mucosa histopathology were assessed at baseline and after each treatment arm.Heated humidification in comparison with sham-heated humidification was associated with decrease in nasal symptomatology, resistance and lavage cytokines, and attenuation of inflammatory cell infiltration and fibrosis of the nasal mucosa.In conclusion, nasal obstruction of OSA patients on CPAP treatment is inflammatory in origin and the addition of heated humidification decreases nasal resistance and mucosal inflammation.

The Link between Rhinitis and Rapid-Eye-Movement Sleep Breathing Disturbances in Children with Obstructive Sleep Apnea

“…2,3 Daytime consequences of this syndrome in children include hyperactivity, excessive daytime sleepiness, and systemic inflammation. 3,4 Recent investigations have confirmed that individuals with OSA have marked nasal inflammatory changes, 5,6 suggesting a potential link between OSA and rhinitis. This association is also suggested by the clinical observation that patients with allergic rhinitis have poor sleep quality according to actigraphic and Pittsburgh Sleep Quality Index variables.…”

Airway Humidification Reduces the Inflammatory Response During Mechanical Ventilation

“…5 However, it has been demonstrated that sufficient airway humidification can reduce the incidence of ventilator-associated pneumonia, the inflammation of the nasal mucous membranes, and the incidence of postoperative pulmonary complications. [7][8][9][10] Todd and John 11 confirmed that airway humidification during mechanical ventilation prevented or reduced acute or chronic lung damage. To date, however, research related to ventilator-associated lung injury in animals has not incorporated the effect of humidification in the disease process, 12,13 particularly since general anesthesia is administered to humans in the absence of humidification.…”

“…We used 10 mL/kg as a normal tidal volume, 27 but previous work demonstrated that low mechanical ventilation tidal volumes also could result in reduced lung capacity and pulmonary inflammation. [20][21][22] Koutsourelakis et al 8 found a reduction in the levels of inflammatory cytokines in nasal lavage fluids following the administration of noninvasive mechanical ventilation with humidification. This suggested that the administration of mechanical ventilation without humidification represents one of the major factors affecting ventilator-associated lung injury that is not only caused by mechanical injury but also caused by insufficient humidification, resulting in inflammation.…”

“…Others have demonstrated that low tidal volumes during mechanical ventilation result in reduced lung capacity and pulmonary inflammation. [20][21][22][23] However, Koutsourelakis et al 8 found that the concentrations of inflammatory cytokines in nasal lavage fluids were reduced when noninvasive ventilation with humidification was used.…”

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

“…The possible benefits of humidification have been controversial, and our in vitro work, in which cells were exposed to high humidity, demonstrates that drying or the absence of humidification alone cannot be solely responsible for the proinflammatory changes observed. An experimental study in rats failed to demonstrate any beneficial effects of heated humidification on nasal inflammation [43], whereas clinical and experimental studies have reported conflicting results on the benefits of humidification [44,45]. Most previous in vitro work has used direct distension [46][47][48], and a mouse model of airway stretch for ventilator-associated lung injury was associated with increased expression of the murine equivalent of IL-8 [13].…”