Sleep Breath 2001; 05(1): 003-012
DOI: 10.1055/s-2001-12788

Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

The Importance of Nasal Resistance in Obstructive Sleep Apnea Syndrome: A Study with Positional Rhinomanometry

Andrea De Vito1 , Stefano Berrettini1 , Anna Carabelli1 , Stefano Sellari-Franceschini1 , Enrica Bonanni2 , Sara Gori2 , Livia Pasquali2 , Luigi Murri2
  • 1E.N.T. Clinic, Department of Neurosciences, Pisa University, Pisa, Italy and
  • 2Neurology Clinic, Department of Neurosciences, Pisa University, Pisa, Italy
Further Information

Publication History

Publication Date:
31 December 2001 (online)


The importance of nasal obstruction in the pathogenesis of obstructive sleep apnea syndrome (OSAS) has not yet been totally defined. Numerous studies have reported an association between nasal obstruction and OSAS, but the precise nature of this relationship remains to be clarified. This study was undertaken to evaluate the prevalence of nasal obstruction disorders in a group of OSAS patients. For this purpose, we analyzed the nasal resistance of 36 OSAS patients by performing a traditional basal anterior active rhinomanometry test (AAR) and a positional AAR, with the patient in a supine position. Seven patients had a pathologic nasal resistance in the seated position that increased further in the supine position; 9 patients had normal resistance in the seated position but a pathologic resistance in the supine position. In 20 patients, nasal resistance was normal in both positions. No statistically significant differences in the degree of apnea/hypopnea index (AHI) was found between the 20 patients with normal positional AAR and the 16 with pathologic positional AAR (p = 0.13). Moreover, no statistically significant differences in the degree of AHI was found between the 7 patients with pathologic basal and positional AAR and the 9 patients with normal basal AAR and pathologic positional AAR (p = 0.38).


  • 1 Guillminault C. Insomnia with sleep apnea: a new syndrome.  Science . 1973;  181 856-858
  • 2 Goode R L. Sleep disorders. In: Cummings CW, Schuller DE, eds. Otolaryngology-Head and Neck Surgery Vol. 1. St. Louis, MO: CV Mosby 1986: 449-457
  • 3 Cimino A, Speciale R, Gallina S. La terapia chirurgica nella sindrome dell'Apnea Ostruttiva nel Sonno (OSAS).  Acta Otorhinol Ital . 1995;  47(suppl 15) 3-14
  • 4 Blakley B W, Mahowald M W. Nasal resistance and sleep apnea.  Laryngoscope . 1987;  97 752-754
  • 5 Cole P, Haight J SJ. Mechanism of nasal obstruction in sleep.  Laryngoscope . 1984;  94 1557-1559
  • 6 Duchna H W. Anamnestic and polygraphic parameters in obstructive sleep apnea syndrome patients with reduced nasal respiration during the day in comparison with obstructive sleep apnea patients with normal nasal respiration.  Wien Med Wochenschr . 1996;  146 348-349
  • 7 Goetz C G, Tanner C M, Aminoff M J. Handbook of Clinical Neurology.  Vol 19 (63): Systemic Diseases. Part I. New York: Elsevier 1993: 452-463
  • 8 Hoffstein V. Snoring and upper airway properties.  Chest . 1988;  94 87-89
  • 9 Hudgel D W. Properties of upper airway during sleep.  Ear Nose Throat J . 1993;  72 42-45
  • 10 Kerr P, Millar T, Buckle P, Kryger M. The importance of nasal resistance in obstructive sleep apnea syndrome.  J Otolaryngol . 1992;  21 189-195
  • 11 Kawano K, Usui N, Kanazawa H, Hara I. Changes in nasal and oral respiratory before and after uvulopalatopharyngoplasty.  Acta Otolaryngol (Stockh) . 1996;  523(suppl) 236-238
  • 12 Lavie P, Fischel N, Zomer J, Eliaschar I. The effects of partial and complete mechanical occlusion of the nasal passages on sleep structure and breathing in sleep.  Acta Otolaryngol (Stockh) . 1983;  95 161-166
  • 13 Lenders H, Schaefer J, Pirsig W. Turbinate hypertrophy in habitual snorers and patients with obstructive sleep apnea: findings of acoustic rhinomanometry.  Laryngoscope . 1991;  101 614-618
  • 14 McNicholas W T. Obstructive apnea during sleep in patients with seasonal allergic rhinitis.  Am Rev Respir Dis . 1982;  126 625-628
  • 15 Metes A, Ohki M, Cole P. Snoring, apnea and nasal resistance in men and women.  J Otolaryngol . 1991;  20 57-61
  • 16 Metes A, Cole P, Hoffstein V, Miljeteg H. Nasal airway dilatation and obstructed breathing in sleep.  Laryngoscope . 1992;  102 1053-1055
  • 17 Miljeteig H, Hoffstein V, Cole P. The effect of unilateral and bilateral nasal obstruction on snoring and sleep apnea.  Laryngoscope . 1992;  102 1150-1152
  • 18 Ohki M, Usui N, Kanazawa H. Relationship between oral breathing and nasal obstruction in patients with obstructive sleep apnea.  Acta Otolaryngol (Stockh) . 1996;  523(suppl) 228-230
  • 19 Papsidero M J. The role of nasal obstruction in obstructive sleep apnea syndrome.  Ear Nose Throat J . 1993;  72 82-84
  • 20 Petruson B. Snoring can be reduced when the nasal airflow is increased by the nasal dilator nozovent.  Arch Otolaryngol Head Neck Surg . 1990;  116 462-464
  • 21 Piché J, Gagnon N B. Snoring, apnea, and nasal resistance.  J Otolaryngol . 1996;  25 150-154
  • 22 Suratt P M. Effect of extranasal obstruction on breathing during sleep.  Chest . 1986;  90 324-329
  • 23 Virkkula P, Lehtonen H, Malmberg H. The effect of nasal obstruction on outcomes of uvulopalatopharyngoplasty.  Acta Otolaryngol (Stockh) . 1997;  529(suppl) 195-198
  • 24 Zwillich C W. Disturbed sleep and prolonged apnea during nasal obstruction in normal men.  Am Rev Respir Dis . 1981;  124 158-160
  • 25 Altissimi G, Simoncelli C, Gallucci L. Rinomanometria posizionale nel soggetto normale.  Acta Otorhinol Ital . 1989;  9 555-563
  • 26 Clement P AR. Committee report on standardization of rhinomanometry.  Rhinology . 1984;  22 151-155
  • 27 Motta G, Salzano F A, Pezzarossa G. Recenti acquisizioni in tema di terapia medica e chirurgica della rinite allergica.  Acta Otorhinolaryngol Ital . 1994;  43(suppl) 87-93
  • 28 Rechtshaffen A, Kales A. A Manual of Standardized Terminology Techniques and Scoring System for Sleep Stages of Human Subjects.  Los Angeles, CA: Brain Information Service, Brain Institute, University of California; 1968
  • 29 Sher A E, Thorpy M J, Spielman A J, Shprintzen R J. Predictive value of Mueller's manoeuver in selection of patients for uvulopalatopharyngoplasty.  Laryngoscope . 1985;  95 1483-1487
  • 30 Riley W R, Powell N, Guilleminault C, Herran J. Cephalometric analysis and flow volume loops in obstructive sleep apnea patients.  Sleep . 1983;  6 304-317
  • 31 Riley W R. Obstructive sleep apnea syndrome: a review of 306 consecutively treated surgical patients.  Otolaryngol Head Neck Surg . 1993;  108 117-125
  • 32 Fujita S, Conway W, Zorik F, Roth T. Surgical correction of anatomical abnormalities in obstructive sleep apnea syndrome-uvulopharyngoplasty.  Otolaryngol Head Neck Surg . 1981;  89 923-934
  • 33 Woodson B T, Garancis J C, Toohill R J. Histopathologic changes in snoring and obstructive sleep apnea syndrome.  Laryngoscope . 1991;  101 1318-1322
  • 34 Zohar Y, Schwartz A, Sabo R. Oropharyngeal fatty infiltration in obstructive sleep apnea patients.  A histopathologic study. Ann Otol Rhinol Laryngol . 1998;  107 170-174