Background: Nasal side effects are often reported during nasal continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea syndrome (OSAS) and may make the use of nasal CPAP difficult. Objective: The aim of this study was to evaluate the effect of nasal CPAP on nasopharyngeal symptoms in OSAS patients. Methods: The frequency and severity of nasopharyngeal symptoms and signs were prospectively evaluated in 49 consecutive OSAS patients (37 men, 12 women, mean (SD) age 54 (7) years, body mass index 35 (6) kg/m2) immediately before and after 6 months’ treatment with nasal CPAP. Results: Nasopharyngeal symptoms were common already before starting nasal CPAP: 74% of patients reported dryness, 53% sneezing, 51% mucus in the throat, 45% blocked nose, and 37% rhinorrhea. During nasal CPAP treatment, severity and frequency of sneezing (75%) and rhinorrhea (57%) increased. This increase was related to the season when nasal CPAP was applied, and was more profound in winter than in summer. Mild abnormalities on rhinoscopy and paranasal sinus X-rays were common both at baseline and at follow-up with no significant change during treatment. Conclusions: Nasopharyngeal problems were found to be frequent in patients with OSAS before nasal CPAP treatment, and tended to increase during the treatment.

1.
Polo O, Berthon-Jones M, Douglas NJ, Sullivan CE: Management of obstructive sleep apnoea/hypopnoea syndrome. Lancet 1994;344:656–660.
2.
Sullivan CE, Berthon-Jones M, Issa FG, Eves L: Reversal of obstructive sleep apnea by continuous positive airway pressure applied through the nares. Lancet 1981;i:862–865.
3.
Engleman HM, Martin SM, Deary IJ, Douglas NJ: Effect of continuous positive airway pressure treatment on daytime function in sleep apnoea/hypopnoea syndrome. Lancet 1994;343:572–575.
4.
Engleman HM, Martin SM, Deary IJ, Douglas NJ: Effect of CPAP therapy on daytime function in patients with mild sleep apnoea/hypopnoea syndrome. Thorax 1997;52:114–119.
5.
American Thoracic Society: Indications and standard for use of nasal continuous positive airway pressure (CPAP) in sleep apnea syndrome. Am J Respir Crit Care Med 1994;150:1738–1745.
6.
Grunstein RR: Nasal continuous positive airway pressure treatment for obstructive sleep apnoea. Thorax 1995;50:1106–1113.
7.
Strumpf DA, Harrop P, Dobbin J, Millman RP: Massive epistaxis from nasal CPAP therapy. Chest 1989;95:1141.
8.
Bamford CR, Quan SF: 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.
9.
Jarjour NN, Wilson P: Pneumocephalus associated with nasal continuous positive airway pressure in a patient with sleep apnea syndrome. Chest 1989;96:1425–1426.
10.
Hudgel DW: The role of upper airway anatomy and physiology in obstructive sleep apnea. Clin Chest Med 1989;13:383–398.
11.
Fairbanks DNF: Snoring: surgical vs nonsurgical management. Laryngoscope 1984;94:1188–1191.
12.
Woodhead CJ, Allen MB: Nasal surgery for snoring. Clin Otolaryngol 1994;19:41–44.
13.
Salmi T, Telakivi T, Partinen M: Evaluation of automatic analysis of SCSB, airflow and oxygen saturation signals in patients with sleep-related apneas. Chest 1989;96:255–261.
14.
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.
15.
Pepin JL, Leger P, Veale D, Langevin B, Robert D, Levy P: 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.
16.
Engleman HM, Asgari-Jirhandeh N, McLeod AL, Ramsay CF, Deary IJ, Douglas NJ: Self-reported use of CPAP and benefits of CPAP therapy: A patient survey. Chest 1996;109:1470–1476.
17.
Jessen M, Janzon L: Prevalence of non-allergic nasal complaints in an urban and a rural population in Sweden. Allergy 1989;44:582–587.
18.
Brander PE, Soirinsuo M, Lohela P: Nasal problems during nasal CPAP treatment of obstructive sleep apnea syndrome. Eur Respir J 1995;8(suppl 19):325S.
19.
Hayes MJ, McGregor FB, Roberts DN, Schroter RC, Pride NB: Continuous nasal positive airway pressure with a mouth leak: Effect on nasal mucosal blood flux and nasal geometry. Thorax 1995;50:1179–1182.
20.
Richards GN, Cistulli PA, Ungar RG, Berthon-Jones M, Sullivan CE: Mouth leak with nasal continuous positive airway pressure increases nasal airway resistance. Am J Respir Crit Care Med 1996;154:182–186.
21.
Kribbs NB, Pack AI, Kline LR, Smith PL, Schwartz AR, Schubert NM, Redline S, Henry JN, Getsy JE, Dinges DF: Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea. Am Rev Respir Dis 1993;147:887–895.
22.
Engleman HM, Martin SM, Douglas NJ: Compliance with CPAP therapy in patients with the sleep apnoea/hypopnoea syndrome. Thorax 1994;49:263–266.
23.
Reeves-Hoche MK, Meck R, Zwillich C: Nasal CPAP: An objective evaluation of patient compliance. Am J Respir Crit Care Med 1994;149:149–154.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.