Nasal Symptoms, Resistance, and AHI Contributions to Subjective Sleep Outcomes

Abstract

Objectives: The contribution of nasal obstruction to sleep related quality of life is poorly understood. This study assesses the contribution of: 1) nasal symptoms and effective nasal resistance;2) AHI to sleep-related quality of life. Methods: 70 unselected adult patients (age 52.2 (13.9) years) undergoing polysomnography at an academic sleep center were evaluated with four phase rhinomanometry (RhinoLab, Rendsburg, Germany ) in the upright and supine body positions and completed validated quality of life measures. Results: AHI demonstrated no associations with nasal obstruction symptom questionnaire (NOSE), insomnia score (PSQI), hypersomnia (ESS), or functional quality of life (FOSQ-10). However, both nasal symptoms (NOSE) and resistance (Rsupine/effective) were associated with sleep metrics. NOSE was associated with insomnia, hypersomnia, and QOL (r = 0.44,0.29, and 0.40 respectively, all p < 0.01) while Rsupine/effective was associated with hypersomnia (r=0.24,p<0.02) and a trend to insomnia (p< 0.09). No association with change in upright to supine resistance was observed. In the group with OSA (AHI > 5/hr., n= 49) and without OSA (AHI < 5/hr.,n=21) nasal symptoms and Rsupine/effective maintained associations (r=0.30 and 0.32 p<0.05) with hypersomnia (ESS) but not AHI (p=NS) in either group. Conclusions: In a sleep lab cohort referred for evaluation of possible sleep disordered breathing, both subjective and objective measures of nasal obstruction but not AHI contribute to sleep related subjective outcomes. Further research is needed on the nasal contribution to sleep disorders independent of AHI.