Morris Luc G, Setlur Jennifer, Burschtin Omar E, Steward David L, Jacobs Joseph B, Lee Kelvin C
Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, NY 10016, USA.
Am J Rhinol. 2006 Mar-Apr;20(2):133-7.
Nasal continuous positive airway pressure (nCPAP) is usually the first-line intervention for obstructive sleep apnea, but up to 50% of patients are unable to tolerate therapy because of discomfort-usually nasal complaints. No factors have been definitively correlated with nCPAP tolerance, although nasal cross-sectional area has been correlated with the level of CPAP pressure, and nasal surgery improves nCPAP compliance. This study examined the relationship between nasal cross-sectional area and nCPAP tolerance.
We performed acoustic rhinometry on 34 obstructive sleep apnea patients at the time of the initial sleep study. Patients titrated to nCPAP were interviewed 18 months after starting therapy to determine CPAP tolerance. Demographic, polysomnographic, and nasal cross-sectional area data were compared between CPAP-tolerant and -intolerant patients.
Between 13 tolerant and 12 intolerant patients, there were no significant differences in age, gender, body mass index, CPAP level, respiratory disturbance index, or subjective nasal obstruction. Cross-sectional area at the inferior turbinate differed significantly between the two groups (p = 0.03). This remained significant after multivariate analysis for possibly confounding variables. A cross-sectional area cutoff of 0.6 cm2 at the head of the inferior turbinate carried a sensitivity of 75% and specificity of 77% for CPAP intolerance in this patient group.
Nasal airway obstruction correlated with CPAP tolerance, supporting an important role for the nose in CPAP, and providing a physiological basis for improved CPAP compliance after nasal surgery. Objective nasal evaluation, but not the subjective report of nasal obstruction, may be helpful in the management of these patients.
鼻持续气道正压通气（nCPAP）通常是阻塞性睡眠呼吸暂停的一线干预措施，但高达50%的患者因不适（通常是鼻部不适）而无法耐受该治疗。尽管鼻横截面积与CPAP压力水平相关，且鼻部手术可提高nCPAP依从性，但尚无明确因素与nCPAP耐受性相关。本研究探讨了鼻横截面积与nCPAP耐受性之间的关系。
我们在34例阻塞性睡眠呼吸暂停患者首次进行睡眠研究时进行了鼻声反射检查。在开始治疗18个月后，对接受nCPAP滴定的患者进行访谈，以确定CPAP耐受性。比较了CPAP耐受组和不耐受组的人口统计学、多导睡眠图和鼻横截面积数据。
在13例耐受患者和12例不耐受患者之间，年龄、性别、体重指数、CPAP水平、呼吸紊乱指数或主观鼻阻塞方面无显著差异。两组下鼻甲处的横截面积存在显著差异（p = 0.03）。在对可能的混杂变量进行多变量分析后，这一差异仍然显著。在下鼻甲头部横截面积截断值为0.6 cm²时，该患者组中CPAP不耐受的敏感性为75%，特异性为77%。
鼻气道阻塞与CPAP耐受性相关，支持鼻部在CPAP中起重要作用，并为鼻部手术后CPAP依从性改善提供了生理基础。客观的鼻评估而非主观的鼻阻塞报告可能有助于这些患者的管理。
