Obstructive sleep apnea among children tied to higher nasal resistance, lower nasal cavity and nasopharyngeal volume

Obstructive Sleep Apnea Syndrome (OSAS) in children has been a subject of debate regarding its association with increased nasal resistance (NR). A recent study delved into this topic, shedding light on the role of nasal ventilation function (NVF) in children with OSAS. This study sheds light on the potential role of nasal ventilation function (NVF) in the pathogenesis of OSAS in children. This study was published in the Ear, Nose & Throat journal by Ying Pang and colleagues.

The study involved children aged 6 to 12, with a total of 109 children in the OSAS group and 116 in the control group. The participants underwent comprehensive assessments, including polysomnography (PSG) to diagnose OSAS, measurement of NR, and acoustic rhinometry (AR) to evaluate nasal structure and function.

Key Results:

• Higher Nasal Resistance: Children with OSAS exhibited significantly higher nasal resistance compared to the control group, underlining the potential relationship between NR and OSAS in pediatric patients.
• Nasal Structure Differences: The OSAS group demonstrated notable differences in nasal structure compared to the control group. Specifically, they had a smaller nasal minimal cross-sectional area (NMCA), reduced nasal cavity volume (NCV) within the first 5 cm, and decreased nasopharyngeal volume (NPV) in the 6 to 8 cm region.
  
• Treatment Response: Among the children with mild to moderate OSAS, 84.1% responded positively to a 12-week treatment regimen involving intranasal corticosteroids (ICS) and oral montelukast (OM). Notably, this responsive group showed significant reductions in tonsil and adenoid size, as well as improvements in NR and AR values.
  
• Partial Improvement: The remaining 15.9% of children did not respond to treatment. However, 26 out of the 32 treated children who exhibited a positive response showed significant improvements in NR, NMCA, and NCV, despite no changes in tonsil and adenoid size or NPV.
  

The findings suggest that increased nasal resistance and structural differences in the nasal passages may contribute to the development of OSAS in pediatric patients. The positive response to treatment in a significant portion of the children underscores the importance of considering interventions that target nasal ventilation function. In particular, a combination of intranasal corticosteroids and oral montelukast was effective in reducing symptoms and improving NR and AR values in children with mild to moderate OSAS.

This study adds valuable insights to the understanding of OSAS in children and highlights the need for a comprehensive approach to its diagnosis and management, which includes assessing nasal ventilation function.

Reference:

Pang, Y., Xiao, L., Liang, J., Zhang, F., Yao, H.-B., & Shu, Y. Role of nasal ventilation function in obstructive sleep apnea syndrome in children. Ear, Nose, & Throat Journal,2023.https://doi.org/10.1177/01455613231205991