Chronic Rhinitis Treatment: Effects on Obstructive Sleep Apnea

Current Treatment Options in Allergy(2022)

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摘要
Purpose of the Review The coexistence of Obstructive Sleep Apnea (OSA) and chronic rhinitis, two very frequent entities with different relevance in terms of morbidity and mortality in general population, is well-known. This review summarizes the relationship of both, and how different treatments for chronic rhinitis can contribute significantly to the management of OSA. The connection between nasal inflammation and continuous positive airway pressure is also characterized. Recent Findings Nasal tolerance to Continous Airway Positive Pressure (CPAP) is sometimes problematic, and the occurrence of nasal irritation may lead to the abandonement of a useful alternative; however, it has been demonstrated through local biomarker measurements, improvement in the inflammation characteristic of chronic rhinitis, after the sustained use of CPAP. The biological markers that explain systemic inflammation in OSA (IL-1, IL-6, TNFα), are related to the development and perpetuation of rhinitis [ 1 •, 2 ••]. Among the rhinitis treatments that improve OSA, nasal corticosteroids should be mentioned in first place, with proven efficacy, especially in the group affected by allergic rinitis, with improvement in the quality of life but not in the apnea and hypopnea index (AHI). Allergic rhinitis is associated with high house dust mites’ concentrations in the CPAP filters [ 3 ] and the addition of nasal steroids improves the associated symptoms. Leukotriene receptor antagonists reduce inflammatory parameters in the pediatric population, and contribute synergistically with nasal steroids, thus reducing the severity of the sleep apnea symptoms [ 4 – 6 ]. Summary This review focuses on chronic rhinitis treatments and their clinical efficacy in reducing the severity of OSA, in adult and pediatric populations, emphasizing on the pathophysiology from Starling’s obstructive model, and on the common inflammatory nature of both clinical conditions. Reducing the load of local inflammatory mediators that cause nasal congestion improves patients with mild OSA, although it is not as effective in patients with moderate and severe symptoms, in whom CPAP remains the best alternative.
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关键词
Chronic rhinitis, Obstructive sleep apnea (OSA), Nasal corticosteroids, Continous positive airway pressure (CPAP), Leukotriene receptor antagonists (LTRA)
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