Topical nasal treatments improve sleep apnea measures in allergic patients; study

Nasal obstruction is a common complaint in patients with sleep-disordered breathing and obstructive sleep apnea OSA. Although topical nasal treatments TNTs have been shown to reduce nasal resistance and improve nasal obstruction, there is conflicting evidence regarding the role of TNTs in adult OSA. Addressing the issue , the review team wrote, "Nasal obstruction has commonly been debated as a risk factor for adult OSA. Several studies have illustrated that nasal obstruction can contribute to higher AHIs4-6 and correlate with OSA39; however, other studies have illustrated that treating nasal obstruction results in no improvements in AHI. Most adults have multiple levels of airway obstruction contributing to OSA. Therefore, individualized assessment of each patient to determine the underlying cause of OSA remains vital for effective treatment."

In this systematic review and meta-analysis the team of researchers aimed to evaluate the role of TNTs in adults with OSA. Data sources used included PubMed, Ovid MEDLINE, and Cochrane Central from January to July .

Inclusion criteria were English-language studies containing original data on TNTs in adults ≥18 years with OSA . Exclusion criteria were case reports, studies without outcome measures,and concurrent non-TNT treatment for OSA. Two investigators independently reviewed all articles and performed quality assessment using validated tools. Meta-analysis and quality assessment were performed.

Data analysis revealed the following facts.

• Of the2180 abstracts identified, 8 studies met inclusion criteria.
• TNTs included decongestants (4 of 8 studies), corticosteroids (3 of 8), and antihistamines (1 of 8). Outcome measures included AHI (8 of 8), respiratory distress index (RDI; 1 of 8), oxygen‐desaturation index (ODI; 3 of 8), minimum SaO2 (MinSaO₂; 4 of 8), nasal resistance (4 of 8), endoscopic sinus surgery (4 of 8 studies) and standardized rhinoconjunctivitis quality of life questionnaire scores (1 of 8 studies).
• Qualitatively, all studies showed trends toward improving objective and subjective measures of OSA, although the significance of these improvements varied across studies.
• A meta‐analysis was performed in 5 studies, but TNTs did not reveal a significant change in AHI (p > 0.05).

"In conclusion, based on the limited evidence, topical nasal sprays do not significantly impact AHI in adult patients with OSA, but they may improve MinSaO2, ODI, RDI, and subjective quality-of-life measures in this population. Allergic patients may have more improvement in OSA measures with use of TNTs when compared with nonallergic patients. Future studies of larger sample sizes are indicated to more accurately determine the efficacy of these treatments."the team opined.

For the full article follow the link: Nguyen D-K Liang J Durr M Topical nasal treatment efficacy on adult obstructive sleep apnea severity a systematic review and meta analysis Int Forum Allergy Rhinol

Primary source: International Forum of Allergy & Rhinology