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. 2016 Mar-Apr;82(2):223-31.
doi: 10.1016/j.bjorl.2015.05.018. Epub 2016 Jan 7.

Systematic review: the influence of nasal obstruction on sleep apnea

Debora Petrungaro Migueis  1 , Luiz Claudio Santos Thuler  2 , Lucas Neves de Andrade Lemes  3 , Chirlene Santos Souza Moreira  1 , Lucia Joffily  4 , Maria Helena de Araujo-Melo  5
Affiliations

Systematic review: the influence of nasal obstruction on sleep apnea

Debora Petrungaro Migueis et al. Braz J Otorhinolaryngol. 2016 Mar-Apr.

Abstract
in English, Portuguese

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.

Introdução: A síndrome da apneia obstrutiva do sono (SAOS) é um distúrbio muito prevalente que pode ocasionar morbi-mortalidade cardiovascular, além de consequências metabólicas, neurológicas e comportamentais. Atualmente, acredita-se que a obstrução nasal comprometa a qualidade do sono, devido a distúrbios respiratórios e fragmentação do sono. Entretanto, até o momento estudos recentes não conseguem relacionar objetivamente qualidade do sono e obstrução nasal.

Objetivo: O objetivo principal desta revisão sistemática é avaliar a influência da obstrução nasal na SAOS e em índices polissonográficos associados a eventos respiratórios.

Método: Foram selecionados um total de 11 artigos originais de 2003 a 2013 com tratamentos cirúrgicos e não cirúrgicos da obstrução nasal, realizando a polissonografia do tipo 1 antes e após a intervenção.

Resultados/conclusões: Na maioria dos ensaios, a obstrução nasal não se relacionou ao índice de apneia-hipopneia, indicando ausência de melhora da SAOS com a redução da resistência nasal. Entretanto, poucos pesquisadores avaliaram índices polissonográficos como o índice de despertares e o percentual do sono REM (movimento rápido dos olhos) que poderiam vir alterados, uma vez que a obstrução nasal possivelmente não obstrui completamente a via aérea superior, mas aumenta a pressão negativa intratorácica, levando à fragmentação do sono.

Keywords: Apneia obstrutiva do sono; Fragmentação do sono; Nasal obstruction; Obstructive sleep apnea; Obstrução nasal; Polissonografia; Polysomnography; Resultado do tratamento; Sleep fragmentation; Treatment outcome.

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Figures

Figure 1
Figure 1
Literature review process. The articles were obtained by using the keywords in BIREME and PubMed. Each reviewer initially assessed 753 articles. After exclusion of articles repeated between sources, titles, and abstracts were evaluated together, which resulted in 73 articles that were assessed in full. There were 25 articles in common and 13 were evaluated according to the STROBE criteria. In addition to these, seven articles were included through manual search of the analyzed references.
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