Anokwute Akudo, Manchanda Shalini, Wallach Paul M
Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
Department of Internal Medicine, Division of General Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
J Clin Sleep Med. 2025 Apr 1;21(4):733-734. doi: 10.5664/jcsm.11454.
Adherence to positive airway pressure (PAP) therapy is a challenge in patients with allergic rhinitis. We present a case of a 62-year-old male with OSA who had been struggling with PAP therapy for 10 years. Intranasal fluticasone alone did not result in tolerance of PAP therapy. However, the combination of once-daily intranasal oxymetazoline with fluticasone led to significant improvement in tolerance and adherence to PAP therapy. Although twice-daily oxymetazoline alone has been associated with developing rhinitis medicamentosa, this side effect was not experienced by our patient. Some studies have shown that using intranasal oxymetazoline along with an intranasal steroid once daily for 4 weeks demonstrated improved effectiveness in relieving nasal symptoms with no development of rebound congestion or rhinitis medicamentosa. This strategy may be helpful in improving continuous PAP tolerance for patients with concurrent obstructive sleep apnea and rhinitis, a potential area to explore in the future to improve PAP adherence.
Anokwute A, Manchanda S, Wallach PM. Improvement of CPAP tolerance and adherence in a patient with obstructive sleep apnea with the use of nasal steroids and nasal oxymetazoline. 2025;21(4):733-734.
对于过敏性鼻炎患者而言，坚持使用气道正压通气（PAP）治疗颇具挑战。我们报告一例62岁男性阻塞性睡眠呼吸暂停（OSA）患者，其在PAP治疗上已苦苦挣扎10年。单独使用鼻内氟替卡松并不能使患者耐受PAP治疗。然而，每日一次的鼻内使用羟甲唑啉与氟替卡松联合使用，使患者对PAP治疗的耐受性和依从性得到显著改善。尽管单独每日两次使用羟甲唑啉会引发药物性鼻炎，但我们的患者并未出现这种副作用。一些研究表明，每日一次将鼻内羟甲唑啉与鼻内类固醇联合使用4周，在缓解鼻部症状方面显示出更高的有效性，且不会出现反弹性充血或药物性鼻炎。这种策略可能有助于提高同时患有阻塞性睡眠呼吸暂停和鼻炎患者对持续气道正压通气（CPAP）的耐受性，这是未来有待探索以提高PAP依从性的一个潜在领域。
阿诺库特A、曼钱达S、瓦拉赫PM。使用鼻用类固醇和鼻用羟甲唑啉改善阻塞性睡眠呼吸暂停患者的CPAP耐受性和依从性。2025年；21(4):733 - 734。
