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• W2060689129 abstract "The nose is properly considered a part of the upper airway. The nasal alae demonstrate inspiratory bursts of activity resulting in nasal flaring, which is precisely timed to precede diaphragm activity.1Strohl KP O'Cain CF Slutsky AS Alae nasi activation and nasal resistance in healthy subjects.J Appl Physiol. 1982; 52: 1432-1437Crossref PubMed Scopus (66) Google Scholar Rhinomanometry has been successfully employed to study nasal airflow. Using this, Bridger and Procter2Bridger GP Procter DF Maximum nasal inspiratory flow and nasal resistance.Ann Otol. 1970; 79: 481-488Google Scholar showed that almost all of the nasal resistance to airflow is produced in the anterior 2 to 3 cm, and that reducing resistance at the nostril has beneficial effects on airflow. Conversely, when nasal resistance is high, a higher total pressure drop is required,2Bridger GP Procter DF Maximum nasal inspiratory flow and nasal resistance.Ann Otol. 1970; 79: 481-488Google Scholar and collapse of the upper airway, specifically the pharyngeal airway, is facilitated. Just as pathologic narrowing of the pharyngeal airway may induce sleep-related impaired breathing,3Orr WC Martin RJ Obstructive sleep apnea associated with tonsillar hypertrophy in adults.Arch Intern Med. 1981; 141: 990-992Crossref PubMed Scopus (65) Google Scholar impairment of nasal breathing has been noted to result in obstructive sleep apnea,4Olsen K Kern E Westbrook P Sleep and breathing disturbance secondary to nasal obstruction.Otolaryngol Head Neck Surg. 1981; 124: 158-160Google Scholar and treatment of nasal pathology in some instances has been beneficial.4Olsen K Kern E Westbrook P Sleep and breathing disturbance secondary to nasal obstruction.Otolaryngol Head Neck Surg. 1981; 124: 158-160Google Scholar5Heimer D Scharf SM Lieberman A Lang P Sleep apnea syndrome treated by repair of deviated nasal septum.Chest. 1983; 84: 184-185Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar Although rhinomanometry has been used to study nasal pathology, Shepard and Burger6Shepard JW Burger CD Nasal and oral flow-volume loops in normal subjects and patients with obstructive sleep apnea.Am Rev Respir Dis. 1990; 142: 1288-1293Crossref PubMed Scopus (79) Google Scholar introduced a more clinically useful method—nasal flow volume loops (FVLs). They showed that the nose behaved like a variable resistor and that the area under the nasal FVLs contributed to the prediction of severity of obstructive sleep apnea. From this he suggested that limitations to ventilation via the nasopharynx may significantly influence the frequency of sleep-disordered breathing. From these observations it is reasonable to speculate that mechanical dilatation of the anterior nares might have an impact on nasal resistance and airflow, and consequently on sleep apnea. A nasal dilator that increases the cross-sectional area of the nasal valve region has been shown in a group of healthy volunteers to improve nasal airflow.7Petruson B Improvement of nasal airflow by the nasal dilator Nozovent.Rhinology. 1988; 26: 289-292PubMed Google Scholar In another study,8Williams AJ Reimer A Stein M Koyal S The effects of a nasal dilator on inspiratory nasal flow: implications for treatment of obstructive sleep apnoea.Hum Psychopharmacol. 1992; 7: 182-183Google Scholar the benefit was seen only in a subgroup, specifically, those with a nasal FVL that exhibited a pattern of variable extrathoracic obstruction, while those with a fixed pattern of obstruction had no improvement in flows. Subsequently, this device was shown to decrease the frequency and severity of obstructed breathing events and snoring in a group of patients with obstructive sleep apnea,9Hoijer U Ejnell H Hedner J Petruson B Eng LB The effects of nasal dilation on snoring and obstructive sleep apnea.Arch Otolaryngol Head Neck Surg. 1992; 118: 281-284Crossref PubMed Scopus (101) Google Scholar and was used to quiet the world's loudest snorer (London Sunday Express, February 16, 1991 p 1). This individual had been reported in the Guinness Book of World Records to produce a sound level of “87.5 decibels at a distance of one meter from the recorder,” and it was noted that his “wife Julie is deaf in one ear.”10Guinness book of world records. New York: Stirling Publishers, 1990; 25Google Scholar In addition, external rhinoplasty with elevation of the nose tip has been used to increase the cross-sectional area of the nares with subsequent improvement in respiratory disturbance during sleep.11Williams AJ Arand D Yan-Go F Clark G Miller T Adjuvant therapies for obstructive sleep apnea [abstract].Am Rev Respir Dis. 1991; 143: A590Crossref PubMed Scopus (54) Google Scholar The importance of the anterior nasal airway in the development or modification of sleep apnea is highlighted by these experiences. The convenience of recording FVLs to assess nasal flow makes them particularly valuable, though, surprisingly, to our knowledge no additional data have been published. Since the problem of snoring, and frequently of accompanying sleep apnea, is significant, we believe that more attention could usefully be paid to the evaluation and improvement of nasal airflow." @default.
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• W2060689129 title "The Nose and Obstructive Sleep Apnea" @default.
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