Nasal Anatomy Abnormalities and Objective Sleep-Disordered Breathing Severity

Abstract

Objectives:

1) Explore the association between nasal anatomy and sleep disordered breathing (SDB) severity as measured by polysomnogram (PSG). 2) Explore the association between nasal anatomy and validated subjective measures of snoring, nasal obstruction, and daytime somnolence.

Methods:

A detailed nasal anatomy assessment on 100 subjects (80% male) including the nasal septum, internal/external nasal valves, and turbinates was performed . Subjects additionally completed the Snore Outcomes Survey (SOS), Nasal Obstruction and Symptom Evaluation (NOSE) instrument, and Epworth Sleepiness survey (ESS) which are all validated, disease-specific surveys. Nasal anatomy assessments were then compared to PSG, SOS, NOSE, and ESS results.

Results:

The mean age was 42 (range=22-72) and mean BMI was 28.9 (range=20.8-39.8). Sixty-nine patients (69%) were found to have OSA (mean AHI=13.1, range=0-64). OSA severity was associated with age (spearmans rho=0.386, p=0.0001), male sex (0.229, p=0.022), BMI (0.279, p=0.005), and neck circumference (0.356, p=0.0003). No nasal anatomy measurement was found to correlate to ESS results or objective SDB severity measured by PSG. The sample size should have provided over 90% power to detect a significant association if one existed. The SOS score was correlated to an observed change in inferior turbinate size with oxymetazalone (-0.252, p=0.116). The NOSE score was correlated to turbinate hypertrophy (0.299, p=0.0025), internal nasal valve collapse (0.258, p=0.0101), and septal deviation (0.204, p=0.418). Subjective snoring was correlated to PSG measured SDB severity (0.273, p=0.0065).

Conclusions:

Abnormal nasal anatomy was not correlated to PSG-measured SDB severity. Specific measurements of abnormal nasal anatomy were correlated to subjective measures of snoring and nasal obstruction.