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Sleep Breath 2003; 07(2): 087-094
DOI: 10.1055/s-2003-40666
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Nasal Breathing and Continuous Positive Airway Pressure (CPAP) in Patients with Obstructive Sleep Apnea (OSA)

Jan H. Hollandt, Malte Mahlerwein
  • Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Germany
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Publication History

Publication Date:
14 July 2003 (online)

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ABSTRACT

Although nasal continuous positive airway pressure (nCPAP) treatment is the most efficient therapy for obstructive sleep apnea (OSA), compliance with therapy is poor because of several side effects. Among these adverse effects some are related to the reactions of the nose to nCPAP which are briefly described. In a long-term survey of 109 OSA patients, 80.6% continued nCPAP for at least 3 years until the last follow-up. Follow-up ranged between 0.8 and 109 months with a mean time of 43 (SD ± 24.7) months. Among all patients treated with nCPAP, only 46.6% met our criteria for long-term compliance, defined as a mean use of the CPAP machine for at least 5 hours per night. Within the objective measures such as age, body mass index, neck circumference, nasal airflow, apnea-hypopnea index, minimal oxygen saturation, and level of nCPAP pressure, no predictive factor for daily use of nCPAP could be found. However, pretherapeutic daytime somnolence (measured by visual analogue scale and Epworth Sleepiness Scale) and its improvement obtained from the therapy showed a significant effect on the daily use of the CPAP machine.

KEYWORDS

Sleep apnea - continuous positive airway pressure - side effects - nasal resistance

REFERENCES

  • 1 Sullivan C E, Berthon-Jones M, Issa F G, Evers L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares.  Lancet . 1981;  1 862-865
    PubMedGoogle Scholar
  • 2 Jenkinson C, Davies R JO, Stradling J R. Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnea: a randomized prospective parallel trial.  Lancet . 1999;  353 2100-2105
    CrossrefPubMedGoogle Scholar
  • 3 Ballester E, Badia J R, Hernandez L. et al . Evidence of effectiveness of continuous positive airway pressure in the treatment of sleep apnea/hypopnea syndrome.  Am J Respir Crit Care Med . 1999;  159 495-501
    CrossrefPubMedGoogle Scholar
  • 4 Brandenburg U, Weiner M, Becker J. et al . Haemodynamics and sleep structure in the discontinued nCPAP test in obstructive sleep apnoea syndrome [German].  Pneumologie . 1993;  47 181-183
    PubMedGoogle Scholar
  • 5 Krieger J, Weitzenblum E, Monassier J P, Stoeckel C, Kurtz D. Dangerous hypoxemia during continuous positive airway pressure treatment of obstructive sleep apnea [letter].  Lancet . 1983;  2 1429-1430
    PubMedGoogle Scholar
  • 6 Anderson A P, Alving J, Lildholdt T, Wulff C. Obstructive sleep apnea initiated by a lax epiglottis: a contraindication for continuous positive airway pressure.  Chest . 1987;  91 621-623
    PubMedGoogle Scholar
  • 7 Pépin J L, Leger P, Veale D. et al . Side effects of nasal continuous positive airway pressure in sleep apnea syndrome. Study of 193 patients in two French sleep centers.  Chest . 1995;  107 375-381
    CrossrefPubMedGoogle Scholar
  • 8 Strumpf D A, Harrop P, Dobbin J, Millman R P. Massive epistaxis from nasal CPAP therapy.  Chest . 1989;  95 1141
    PubMedGoogle Scholar
  • 9 Jarjour N N, Wilson P. Pneumocephalus associated with nasal continuous positive airway pressure in a patient with sleep apnea syndrome.  Chest . 1989;  96 1425-1426
    CrossrefPubMedGoogle Scholar
  • 10 Bamford C R, Quan S F. Bacterial meningitis-a possible complication of nasal continuous positive airway pressure therapy in a patient with obstructive sleep apnea syndrome and a mucocele.  Sleep . 1993;  16 31-32
    PubMedGoogle Scholar
  • 11 Zwacka G, Scholle S, Kemper G, Rieger B. Nasal CPAP therapy for infants with congenital stridor.  Sleep Breath. 1997/98;  2 085-096
    PubMedGoogle Scholar
  • 12 Loftus B C, Ahn J, Haddad J. Neonatal nasal deformities secondary to nasal continuous positive airway pressure.  Laryngoscope. 1994;  104 1019-1022
    PubMedGoogle Scholar
  • 13 Mortimore I L, Whittle A T, Douglas N J. Comparison of nose and face mask CPAP therapy for sleep apnoea.  Thorax . 1998;  53 290-292
    CrossrefPubMedGoogle Scholar
  • 14 Verse T. Nebenwirkungen der nasalen CPAP-Ventilationstherapie.  HNO . 2000;  48 706-715
    CrossrefPubMedGoogle Scholar
  • 15 Verse T, Lehnhardt E, Pirsig W, Junge-Hülsing B, Kroker B. Otorhinolaryngological side effects of nocturnal nasal ventilation therapy with continuous positive airway pressure (nCPAP).  Laryngorhinootologie . 1999;  78 491-496
    PubMedGoogle Scholar
  • 16 Wiest G H, Ficker J H, Müller A, Hahn E G. Nebenwirkungen der nCPAP-Therapie beim obstruktiven Schlafapnoesyndrom. Ursachen und Therapie.  Atemw-Lungenkrkh . 1998;  24 95-102
    PubMedGoogle Scholar
  • 17 Lojander J, Brander P E, Ämmälä K. Nasopharyngeal symptoms and nasal continuous positive airway pressure therapy in obstructive sleep apnea syndrome.  Acta Otolaryngol . 1999;  119 497-502
    CrossrefPubMedGoogle Scholar
  • 18 Kalan A, Kenyon G S, Seemungal T AR, Wedzicha A. Adverse effects of positive airway pressure therapy in sleep apnoea syndrome.  J Laryngol Otol . 1999;  113 888-892
    PubMedGoogle Scholar
  • 19 Nino-Murcia G, McCann C C, Bliwise D L, Guilleminault C, Dement W C. Compliance and side effects in sleep apnea patients treated with nasal continuous positive airway pressure.  West J Med . 1989;  150 165-169
    PubMedGoogle Scholar
  • 20 Togias A G, Naclerio R M, Proud D. et al . Nasal challenge with cold, dry air results in release of inflammatory mediators: possible mast cell involvement.  J Clin Invest . 1985;  76 1375-1381
    PubMedGoogle Scholar
  • 21 Constantinidis J, Knöbber D, Steinhart H, Kuhn J, Iro H. Fine-structural investigations of the effect of nCPAP-mask application on the nasal mucosa.  Acta Otolaryngol . 2000;  120 432-437
    CrossrefPubMedGoogle Scholar
  • 22 Richards G N, Cistulli P A, Ungar R G, Berthon-Jones M, Sullivan C E. Mouth leak with nasal continuous positive airway pressure increases nasal airway resistance.  Am J Respir Crit Med . 1996;  154 182-186
    PubMedGoogle Scholar
  • 23 Becker H, Fett I, Nees E, Peter J H, von Wichert P. Behandlung primärer und sekundärer Therapieversager der nCPAP-Behandlung bei Patienten mit Schlafapnoe.  Pneumologie . 1991;  45 301-305
    PubMedGoogle Scholar
  • 24 Wiest G H, Lehnert G, Brück W M. et al . A heated humidifier reduces upper airway dryness during continuous positive airway pressure therapy.  Resp Med . 1999;  93 21-26
    PubMedGoogle Scholar
  • 25 Grunstein R R. Sleep-related breathing disorders. 5. Nasal continuous positive airway pressure treatment for obstructive sleep apnea.  Thorax . 1995;  50 1106-1113
    PubMedGoogle Scholar
  • 26 Coppola M P. Controversies in sleep medicine-essay: The Emperor (and my patient) has no nose.  Sleep Breath . 1999;  3 107
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Massie C A, Hart R W, Peralez K, Richards G N. Effects of humidification on nasal symptoms and compliance in sleep apnea patients using continuous positive airway pressure.  Chest . 1999;  116 403-408
    CrossrefPubMedGoogle Scholar
  • 28 Krieger J, Kurtz D. Objective measurement of compliance with nasal CPAP treatment for obstructive sleep apnoea syndrome.  Eur Respir J . 1988;  1 436-438
    PubMedGoogle Scholar
  • 29 Waldhorn R E, Herrick T W, Nguyen M C. et al . Long-term compliance with nasal continuous positive airway pressure therapy of obstructive sleep apnea.  Chest . 1990;  97 33-38
    PubMedGoogle Scholar
  • 30 Rauscher H, Popp W, Wanke T, Zwick H. Acceptance of CPAP therapy for sleep apnea.  Chest . 1991;  100 1019-1023
    PubMedGoogle Scholar
  • 31 Hoffstein V, Viner S, Mateika S, Conway J. Treatment of obstructive sleep apnea with nasal continuous positive airway pressure. Patient compliance, perception of benefits, and side effects.  Am Rev Respir Dis . 1992;  145 841-845
    CrossrefPubMedGoogle Scholar
  • 32 Engleman H M, Martin S E, Douglas N J. Compliance with CPAP-therapy in patients with sleep apnea/hypopnea syndrome.  Thorax . 1994;  49 263-266
    PubMedGoogle Scholar
  • 33 Hollandt J H, Kuhl S, Siegert R. Treatment of patients with the obstructive sleep apnoea syndrome (OSAS) using nasal continuous positive airway pressure (nCPAP). Part I: Long-term compliance with nCPAP.  Laryngorhinootologie . 1997;  76 550-553
    PubMedGoogle Scholar
  • 34 Partinen M, Jamieson A, Guilleminault C. Long-term outcome for obstructive sleep apnea syndrome patients' mortality.  Chest . 1988;  94 1200-1204
    CrossrefPubMedGoogle Scholar
  • 35 Rasche K, Orth M, Duchna H W, Ullrich H W, Schultze-Werninghaus G. CPAP-Therapie bei obstruktivem Schlafapnoesyndrom: Nebenwirkungen und Akzeptanz im Langzeitverlauf.  Med Klinik . 1994;  89 86-88
    PubMedGoogle Scholar
  • 36 Kuhl S, Hollandt J H, Siegert R. Treatment of patients with obstructive sleep apnea syndrome (OSAS) with nasal continuous positive airway pressure (nCPAP). Part II: Side effects of nCPAP therapy-influence on long-term compliance.  Laryngorhinootologie . 1997;  76 608-613
    PubMedGoogle Scholar
  • 37 Hollandt J H, Mahlerwein M, Klaiber S, Siegert R. Langzeitakzeptanz von nCPAP (nasal continuous positive airway pressure) bei Patienten mit obstruktivem Schlafapnoe Syndrom [abstract].  HNO Informationen . 2002;  27 136
    PubMedGoogle Scholar
  • 38 Johns M W. Reliability and factor analysis of the Epworth Sleepiness Scale.  Sleep . 1992;  15 376-381
    Google Scholar
  • 39 Meurice J C, Dore P, Paquereau J. et al . Predictive factors of long-term compliance with nasal continuous positive airway pressure treatment in sleep apnea syndrome.  Chest . 1994;  105 429-433
    PubMedGoogle Scholar
  • 40 Mayer-Brix J, Becker H, Peter J H. Nasal high pressure ventilation in obstructive sleep apnea syndrome. Theoretical and practical otorhinolaryngological aspects [German].  Laryngorhinootologie . 1989;  68 295-298
    PubMedGoogle Scholar
  • 41 Sériès F; Pierre S S, Carrier G. Effects of surgical correction of nasal obstruction in the treatment of obstructive sleep apnea.  Am Rev Respir Dis . 1992;  146 1261-1265
    PubMedGoogle Scholar
  • 42 Ripberger R, Pirsig W. Long-term compliance with nasal CPAP treatment for obstructive sleep apnoea: prospective study in 50 patients [German].  Laryngorhinootologie . 1994;  73 581-585
    PubMedGoogle Scholar
  • 43 Friedmann M, Tanyeri H, Lim J W. et al . Effects of improved nasal breathing on obstructive sleep apnea.  Otolaryngol Head Neck Surg . 2000;  122 71-74
    PubMedGoogle Scholar
  • 44 Biermann E. Nasal CPAP-therapy in obstructive sleep apnea syndrome: does functional rhinosurgery improve compliance?.  Somnologie . 2001;  5 59-64
    CrossrefPubMedGoogle Scholar
  • 45 Dorn M, Pirsig W, Verse T. Management of patients with severe obstructive sleep apnea following rhinosurgical interventions. A pilot study.  HNO . 2001;  49 642-645
    CrossrefPubMedGoogle Scholar
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