Nose and sleep breathing disorders

Sleep-disordered breathing (SDB) is a clinical entity that consists of a wide spectrum of sleep-related breathing abnormalities. Those related to upper airway obstruction include snoring, upper airway resistance syndrome (UARS) and obstructive sleep apnoea-hypopnoea syndrome (OSAHS). The latter is a leading cause of neuropsychological, cerebro- and cardiovascular diseases, metabolic disorders, loss in work productivity and increased risk of motor vehicle accidents. As the nose plays an important role in the physiology of the respiratory tract, the authors remind the anatomy and physiology of the nose and the role of the nasal disorders in the pathogenesis of SDB. They also review the different methods to treat nasal obstruction, medically or surgically. To summarise, the authors point out that reducing nasal obstruction and resistance improves subjectively the snoring, the daytime sleepiness and the quality of life, but fails to improve significantly objective polysomnography data, such as the apnoea-hypopnoea index (AHI) or nocturnal oxygen desaturation. When some positive effects have been reported, improvement of sleep apnoea occurred only in approximately 15-20 % of the patients. Results of nasal surgery in patients with sleep apnoea/hypopnoea are therefore barely predictable. Nevertheless, nasal procedures improve CPAP compliance in individuals with OSA and nasal obstruction requiring high CPAP settings. A global management of the patient with a multilevel airway approach is therefore recommended to treat in an optimal way sleep-disordered breathing