Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Sep;23(3):785-793.
doi: 10.1007/s11325-018-1760-1. Epub 2018 Dec 12.

Measurement of fractional exhaled nitric oxide and nasal nitric oxide in male patients with obstructive sleep apnea

Dongmei Zhang  1   2 , Yi Xiao  3 , Jinmei Luo  1 , Xiaona Wang  1 , Yixian Qiao  1 , Rong Huang  1 , Wei Wu  4
Affiliations

Measurement of fractional exhaled nitric oxide and nasal nitric oxide in male patients with obstructive sleep apnea

Dongmei Zhang et al. Sleep Breath. 2019 Sep.

Abstract

Objective: Airway inflammation plays an important role in obstructive sleep apnea (OSA); exhaled nitric oxide is regarded as a noninvasive marker of airway inflammation. The aim of this study was to evaluate fractional exhaled nitric oxide (FeNO) and nasal nitric oxide (nNO) in patients with OSA.

Methods: Seventy-five patients with OSA and 30 health controls were enrolled in this study. FeNO and nNO were measured before and after sleep. Nasal lavage was performed in 31 non-smoking individuals immediately after NO measurement in the morning. The sample of nasal lavage was taken for cell classification and analyzing interleukin 6 (IL-6) and interleukin 8 (IL-8).

Results: Both FeNO and nNO were significantly higher in OSA (before sleep FeNO 21.08 ± 8.79 ppb vs.16.90 ± 6.86 ppb, p = 0.022; after sleep FeNO 25.57 ± 15.58 ppb vs.18.07 ± 6.25 ppb, p = 0.003; before sleep nNO 487.03 ± 115.83 ppb vs. 413.37 ± 73.10 ppb, p = 0.001; after sleep nNO 550.07 ± 130.24 ppb vs. 460.43 ± 109.77 ppb, p < 0.001). Furthermore, in non-smoking OSA, nNO levels were positively correlated with apnea hypopnea index (AHI) and average decrease of pulse arterial oxygen saturation (SpO2); after sleep, nNO was also positively associated to recording time with SpO2 < 90% and negatively associated to minimum SpO2. Both before and after sleep nNO levels were positively correlated with the percentage of neutrophils in nasal lavage (r = 0.528, p = 0.014; r = 0.702, p < 0.001, respectively). Additionally, before sleep nNO was also positively associated with IL-6 (r = 0.586, p = 0.005) and IL-8 (r = 0.520, p = 0.016) concentration.

Conclusion: This study sustains the presence of airway inflammation in OSA patients with the increase of FeNO and nNO. The data suggests nNO might have greater value than FeNO since it positively correlated with OSA severity, and nNO is a potential bio-marker of nasal inflammation in non-smoking OSA patients.

Keywords: Airway inflammation; Exhaled nitric oxide; Fractional exhaled nitric oxide; Nasal nitric oxide; Obstructive sleep apnea.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Measurement of FeNO and nNO in patients with OSA and health controls before and after sleep
Fig. 2
Fig. 2
Correlation between nNO and AHI, percentage of neutrophil, IL-6, and IL-8 in nasal lavage of non-smoking OSA
Fig. 3
Fig. 3
ROC curve of predicting the patients with OSA among non-smoking subjects (n = 84). Area under ROC curve 0.731 ± 0.060 (p < 0.001, 95% CI 0.613–0.848)
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Bikov A, Hull JH, Kunos L. Exhaled breath analysis, a simple tool to study the pathophysiology of obstructive sleep apnoea. Sleep Med Rev. 2016;27:1–8. doi: 10.1016/j.smrv.2015.07.005. - DOI - PubMed
    1. Munakata M. Exhaled nitric oxide (FeNO) as a non-invasive marker of airway inflammation. Allergol Int. 2012;61(3):365–372. doi: 10.2332/allergolint.12-RAI-0461. - DOI - PubMed
    1. Zhang D, Luo J, Qiao Y, Xiao Y, Huang R, Zhong X. Measurement of exhaled nitric oxide concentration in patients with obstructive sleep apnea: a meta-analysis. Medicine (Baltimore) 2017;96(12):e6429. doi: 10.1097/MD.0000000000006429. - DOI - PMC - PubMed
    1. Williamson PA, Vaidyanathan S, Clearie K, Stewart M, Lipworth BJ. Relationship between fractional exhaled nitric oxide and nasal nitric oxide in airways disease. Ann Allergy Asthma Immunol. 2010;105(2):162–167. doi: 10.1016/j.anai.2010.05.014. - DOI - PubMed
    1. Jorissen M, Lefevere L, Willems T. Nasal nitric oxide. Allergy. 2001;56(11):1026–1033. doi: 10.1034/j.1398-9995.2001.00145.x. - DOI - PubMed

LinkOut - more resources