Nose and Sleep Breathing Disorders

Abstract

• The nose is the input channel for the airfl ow. Its rigid and erectile structures determine the outline and the output of the airfl ow in the upper airway. Nose obstruction, due to reversible or nonreversible factors, produces collapsing forces that are manifest downstream in the collapsible pharynx. Moreover, nose pathologies result in unstable oral breathing, decreased activation of nasalventilatory refl ex and reduced lung nitric oxide. Long-term oral breathing impacts on the craniofacial growth. The management of nose pathologies could be medical, mechanical (nose dilators) or surgical. Nasal management should be integrated in a multimodal approach, considering the involvement of a multilevel obstruction, and truly refl ecting the complexity of sleep disordered breathing.

Clinical associations between allergies and rapid eye movement sleep disturbances

“…We demonstrated that allergens have a significant effect preferentially on the REM‐RDI independent of all‐night AHI, RDI, and REM‐AHI. Earlier studies have concluded that nasal congestion in AR is a primary contributor to the increase in the number of apneic episodes, RERAs, and microarousals that cause sleep disturbances . In children with AR and moderate to severe OSA, a significantly elevated AHI was seen during REM sleep .…”

“…We had hypothesized that already inflamed situationally paralyzed upper airway structures would preferentially narrow air passages during REM due to REM stage–specific skeletal muscle atonia. Despite the pharynx often being focused on as the primary area of obstruction in OSA, upstream nasal resistance can limit downstream pharyngeal airflow . Throughout human evolution, narrowing of the upper aerodigestive tract compensated for the predisposition to speech and language.…”

“…The association of increased congestion during REM sleep has been demonstrated through objective serial acoustic rhinometry and is followed by decongestion in the NREM stages . Increases in nocturnal nasal congestion, often exacerbated by lying in a supine position, may be even more relevant during REM sleep where muscle paralysis plays a role in the collapse of an already obstructed nose …”

Anatomy and Pathophysiology of Upper Airway Obstructive Sleep Apnoea: Review of the Current Literature

“…Impaired nasal ventilatory reflex reduces spontaneous ventilation [23,28] causing failure of activation of the UA dilator muscles [23]. This condition worsens apnoea episodes because UA dilator muscle tone is inhibited, consequently reducing breathing and minute lung ventilation [16,17,24,29].…”