Clinical investigations over the last decade have revealed that sleep may not be the benign rejuvenating state it was once considered. Sleep apnea is now frequently recognized, and it is clear that patency of the nasal passages and the nasopharynx is crucial for successful treatment of the syndrome. Furthermore, partial or complete nasal obstruction even in normal subjects can cause sleep disruption, hypopneas, and apneas. This may partially explain some of the daytime drowsiness seen in patients with conditions such as allergic rhinitis.
Get full access to this article
View all access options for this article.
References
1.
ShoreE.T., MillmanR.P., SilageD.A., ChungD-CC, PackA.I.Ventilatory and arousal patterns during sleep in normal young and elderly subjects. J Appl Physiol59: 1607–1615, 1985.
2.
MillmanR.P., KnightH., KlineL.R., ShoreE.T., ChungD.C.C., PackA.I.Changes in compartmental ventilation in association with eye movements during REM sleep. J Appl Physiol65: 1196–1202, 1988.
3.
FletcherE.C., GrayB.A., LevinD.C.Nonapneic mechanisms of arterial oxygen desaturation during rapid-eye-movement sleep. J Appl Physiol54: 632–639, 1983.
4.
GuilleminaultC., van den HoedJ., MitlerM.M.Clinical overview of the sleep apnea syndromes. In: GuilleminaultC., DementW.C., eds. Sleep Apnea Syndromes, New York: Alan R Liss, 1978, pp. 1–12.
5.
KnightH., MillmanR.P., GurR.C., SaykinA.J., DohertyJ.U., PackA.I.Clinical significance of sleep apnea in the elderly. Am Rev Respir Dis136: 845–850, 1987.
MillmanR.P.Snoring and apnea. Clin Chest Med8: 253–264, 1987.
9.
TilkianA.G., GuilleminaultC., SchroederJ.S., LehrmanK.L., SimmonsB., DementW.C.Hemodynamics in sleep-induced apnea. Studies during wakefulness and sleep. Arch Intern Med143: 714–719, 1976.
10.
GuilleminaultC., ConnollyS., WinkleR., MelvinK., TilkianA.Cyclical variation of the heart rate in sleep apnea syndrome. Mechanisms and usefulness of 24 h electrocardiography as a screening technique. Lancet1: 126–131, 1984.
11.
ShepardJ.W.Hemodynamics in obstructive sleep apnea. In: FletcherE.C., Ed. Abnormalities of Respiration during Sleep. Diagnosis, Pathophysiology and Treatment.Orlando, FL: Grune & Stratton, 1986, pp. 39–61.
12.
ShepardJ.W.Jr., GarrisonM.W., GritherB.S., DolanG.F.Relationship of ventricular ectopy to oxyhemoglobin desaturation in patients with obstructive sleep apnea. Chest88: 335–340, 1985.
13.
FletcherE.C., DeBehnkeR.D., LovoiM.S., GorinA.B.Undiagnosed sleep apnea in patients with essential hypertension. Ann Intern Med103: 190–195, 1985.
14.
KalesA., BixlerE.O., CadieuxR.J., SchneckD.W., ShawLCIII, LockeT.W., Vela-BuenoA., SoldatosC.R.Sleep apnoea in a hypertensive population. Lancet2: 1005–1008, 1984.
15.
SurattP.M., WilhoitS.C., CooperK.Induction of airway collapse with subatmospheric pressure in awake patients with sleep apnea. J Appl Physiol57: 140–146, 1984.
KrolR.C., KnuthS.L., BartlettD.Jr.. Selective reduction of genioglossal muscle activity by alcohol in normal human subjects. Am Rev Respir Dis129: 247–250, 1984.
18.
BlockA.J., WynneJ.W., BoysenP.G.Sleep-disordered breathing and nocturnal oxygen desaturation in postmenopausal women. Am J Med69: 75–79, 1980.
19.
TaasanV., WynneJ.W., CassisiN., BlockA.J.The effect of nasal packing on sleep-disordered breathing and nocturnal oxygen desaturation. Laryngoscope91: 1163–1172, 1981.
20.
LavieP., ZomerJ., EliascharI., JoachimZ., HalpernE., RubinA-HE, AlroyG.Excessive daytime sleepiness and insomnia. Association with deviated nasal septum and nocturnal breathing disorders. Arch Otolaryngol108: 373–377, 1982.
21.
LavieP., GertnerR., ZomerJ., PodoshinL.Breathing disorders in sleep associated with “microarousals” in patients with allergic rhinitis. Acta Otolaryngol92: 529–533, 1981.
22.
McNicholasW.T., TarloS., ColeP., ZamelN., RutherfordR., GriffinD., PhillipsonE.A.Obstructive apneas during sleep in patients with seasonal allergic rhinitis. Am Rev Respir Dis126: 625–628, 1982.
23.
LeznoffA., HaightJ.S., HoffsteinV.Reversible obstructive sleep apnea caused by occupational exposure to guar gum dust. Am Rev Respir Dis133: 935–936, 1986.
24.
ZwillichC.W., PickettC., HansonF.N., WeilJ.V.Disturbed sleep and prolonged apnea during nasal obstruction in normal men. Am Rev Respir Dis124: 158–160, 1981.
25.
OlsenK.D., KernE.B., WestbrookP.R.Sleep and breathing disturbance secondary to nasal obstruction. Otolaryngol Head Neck Surg89: 804–810, 1981.
26.
SurattP.M., TurnerB.L., WilhoitS.C.Effect of intranasal obstruction on breathing during sleep. Chest90: 324–329, 1986.
27.
SurattP.M., McTierR.F., WilhoitS.C.Collapsibility of the nasopharyngeal airway in obstructive sleep apnea. Am Rev Respir Dis132: 967–971, 1985.
28.
BlakelyB.W., MahowaldM.W.Nasal resistance and sleep apnea. Laryngoscope97: 752–754, 1987.
29.
GleesonK., ZwillichC.W., BraierK., WhiteD.P.Breathing route during sleep. Am Rev Respir Dis134: 115–120, 1986.
30.
MathewO.P.Upper airway negative pressure effects on respiratory activity of upper airway muscles. J Appl Physiol56: 500–505, 1984.
31.
CarloW.A., MillerM.J., MartinR.J.Differential response of respiratory muscles to airway occlusion in infants. J Appl Physiol59: 847–852, 1985.
32.
KunaS.T., SmickleyJ.Response of genioglossus muscle activity to nasal airway occlusion in normal sleeping adults. J Appl Physiol64: 347–353, 1988.
33.
DayalV.S., PhillipsonE.A.Nasal surgery and the management of sleep apnea. Ann Otol Rhinol Laryngol94: 550–554, 1984.
34.
HeimerD.H., ScharfS.M., LiebermanA., LavieP.Sleep apnea syndrome treated by repair of deviated nasal septum. Chest84: 184–185, 1983.
35.
RubinA.H.E., EliascharI., JoachimZ., AlroyG., LavieP.Effects of nasal surgery and tonsillectomy on sleep apnea. Bull Eur Physiopathol Respir19: 612–615, 1983.
36.
SandersM.H.Nasal CPAP effect on patterns of sleep apnea. Chest86: 839–844, 1984.
37.
SullivanC.E., Berthon-JonesM., IssaR.Q.Remission of severe obesity-hypoventilation syndrome after short-term treatment during sleep with nasal continuous positive airway pressure. Am Rev Respir Dis128: 177–181, 1983.
38.
StrohlK.P., RedlineS.Nasal CPAP therapy, upper airway activation, and obstructive sleep apnea. Am Rev Respir Dis134: 555–558, 1986.