Kohler M, Bloch K E, Stradling J R
Oxford Centre for Respiratory Medicine, Oxford OX3 7LJ, UK.
Eur Respir J. 2007 Dec;30(6):1208-15. doi: 10.1183/09031936.00032007.
Data from observational studies suggest that nasal obstruction contributes to the pathogenesis of snoring and obstructive sleep apnoea (OSA). To define more accurately the relationship between snoring, OSA and nasal obstruction, the current authors have summarised the literature on epidemiological and physiological studies, and performed a systematic review of randomised controlled trials in which the effects of treating nasal obstruction on snoring and OSA were investigated. Searches of bibliographical databases revealed nine trials with randomised controlled design. External nasal dilators were used in five studies, topically applied steroids in one, nasal decongestants in two, and surgical treatment in one study. Data from studies using nasal dilators, intranasal steroids and decongestants to relieve nasal congestion showed beneficial effects on sleep architecture, but only minor improvement of OSA symptoms or severity. Snoring seemed to be reduced by nasal dilators. Nasal surgery also had minimal impact on OSA symptoms. In conclusion, chronic nasal obstruction seems to play a minor role in the pathogenesis of obstructive sleep apnoea, and seems to be of some relevance in the origin of snoring. The impact of treating nasal obstruction in patients with snoring and obstructive sleep apnoea on long-term outcome remains to be defined through randomised controlled trials of medical and surgical therapies.
观察性研究的数据表明，鼻阻塞是打鼾和阻塞性睡眠呼吸暂停（OSA）发病机制的一个因素。为了更准确地界定打鼾、OSA和鼻阻塞之间的关系，本文作者总结了流行病学和生理学研究方面的文献，并对调查鼻阻塞治疗对打鼾和OSA影响的随机对照试验进行了系统评价。对书目数据库的检索发现了9项随机对照设计的试验。5项研究使用了鼻外扩张器，1项使用了局部应用类固醇，2项使用了鼻减充血剂，1项研究采用了手术治疗。使用鼻扩张器、鼻内类固醇和减充血剂缓解鼻充血的研究数据显示对睡眠结构有有益影响，但对OSA症状或严重程度仅有轻微改善。鼻扩张器似乎能减轻打鼾。鼻手术对OSA症状的影响也很小。总之，慢性鼻阻塞在阻塞性睡眠呼吸暂停的发病机制中似乎起次要作用，在打鼾的起源中似乎有一定关联。对于打鼾和阻塞性睡眠呼吸暂停患者，治疗鼻阻塞对长期预后的影响仍有待通过药物和手术治疗的随机对照试验来确定。
