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The Nose and Sleep-Disordered Breathing^*

What We Know and What We Do Not Know

^* From the Divisions of Pulmonary/Critical Care Medicine (Dr. Rappai) and Allergy/Immunology (Drs. Kemp and deShazo), University of Mississippi Medical Center; Jackson, MS; and the Division of Pulmonary/Critical Care Medicine (Dr. Collop), Johns Hopkins University, Baltimore, MD.

Correspondence to: Nancy Collop, MD, FCCP, Division of Pulmonary/Critical Care Medicine, Johns Hopkins University DOM, 600 North Wolfe St, Blalock 910, Baltimore, MD 21287; e-mail: ncollop{at}aol.com

The relationship between sleep-disordered breathing (SDB) and nasal obstruction is unclear. In order to better understand, we performed an extensive computer-assisted review and analysis of the medical literature on this topic. Data were grouped into reports of normal control subjects, patients with isolated nasal obstruction, and those with SDB. We conclude that SDB can both result from and be worsened by nasal obstruction. Nasal breathing increases ventilatory drive and nasal occlusion decreases pharyngeal patency in normal subjects. Nasal congestion from any cause predisposes to SDB. Although increased nasal resistance does not always correlate with symptoms of congestion, nasal congestion typically results in a switch to oronasal breathing that compromises the airway. Moreover, oral breathing in children may lead to the development of facial structural abnormalities associated with SDB. We postulate that the switch to oronasal breathing that occurs with chronic nasal conditions is a final common pathway for SDB.

Key Words: nasal obstruction • nose • obstructive sleep apnea syndrome • rhinitis • sleep-disordered breathing

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