Systematic review: the influence of nasal obstruction on sleep apnea

ABSTRACT INTRODUCTION: Obstructive sleep apnea syndrome (OSAS) is a common disorder that can lead to cardiovascular morbidity and mortality, as well as to metabolic, neurological, and behavioral consequences. It is currently believed that nasal obstruction compromises the quality of sleep when it results in breathing disorders and fragmentation of sleep. However, recent studies have failed to objectively associate sleep quality and nasal obstruction. OBJECTIVE: The aim of this systematic review is to evaluate the influence of nasal obstruction on OSAS and polysomnographic indices associated with respiratory events. METHODS: Eleven original articles published from 2003 to 2013 were selected, which addressed surgical and non-surgical treatment for nasal obstruction, performing polysomnography type 1 before and after the intervention. RESULTS/CONCLUSIONS: In most trials, nasal obstruction was not related to the apnea-hypopnea index (AHI), indicating no improvement in OSAS with reduction in nasal resistance. However, few researchers evaluated other polysomnography indices, such as the arousal index and rapid eye movement (REM) sleep percentage. These could change with nasal obstruction, since it is possible that the nasal obstruction does not completely block the upper airways, but can increase negative intrathoracic pressure, leading to sleep fragmentation.

引言：阻塞性睡眠呼吸暂停综合征（Obstructive Sleep Apnea Syndrome, OSAS）是一种常见疾病，可引发心血管疾病的发病率与死亡率升高，还会带来代谢、神经及行为方面的不良后果。当前学界普遍认为，鼻腔阻塞若导致呼吸障碍与睡眠碎片化，会降低睡眠质量。但近期研究未能客观证实睡眠质量与鼻腔阻塞之间存在明确关联。
研究目的：本系统综述旨在评估鼻腔阻塞对阻塞性睡眠呼吸暂停综合征（OSAS）以及与呼吸事件相关的多导睡眠监测（Polysomnography）指标的影响。
研究方法：本研究选取了2003年至2013年间发表的11篇原创性论文，这些研究均针对鼻腔阻塞的手术与非手术治疗方案，且在干预前后均完成了1型多导睡眠监测（Polysomnography Type 1）。
结果与结论：多数试验结果显示，鼻腔阻塞与呼吸暂停低通气指数（Apnea-Hypopnea Index, AHI）并无显著关联，提示降低鼻腔阻力并未改善阻塞性睡眠呼吸暂停综合征（OSAS）的病情。不过仅有少数研究者评估了其他多导睡眠监测指标，如觉醒指数与快速眼动（Rapid Eye Movement, REM）睡眠占比。这类指标可能随鼻腔阻塞发生变化，这是因为鼻腔阻塞未必会完全阻塞上气道，却可能升高胸腔内负压，进而引发睡眠碎片化。