The Relationship Between Subjective and Objective Nasal Obstruction and Polysomnographic Parameters in Obstructive Sleep Apnea Publisher



Erfanian R ; Irani S ; Heidari R ; Alamdari MK
Source: American Journal of Otolaryngology - Head and Neck Medicine and Surgery Published:2025

Abstract

Background: Nasal obstruction has been identified as a significant factor in the development and exacerbation of obstructive sleep apnea (OSA). This study aimed to explore the correlation between objective and subjective measures of nasal obstruction with polysomnographic features. Methods: A cross-sectional study was conducted on 100 patients suspected of OSA. Participants completed the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire to assess subjective nasal obstruction. Objective nasal airflow was measured using peak nasal expiratory flow (PNEF). All participants underwent type I polysomnography to assess sleep-related breathing disturbances. Correlations between NOSE scores, PNEF, and various polysomnographic parameters, including the apnea-hypopnea index (AHI), mean oxygen saturation, time spent below 90 % oxygen saturation, lowest oxygen saturation, and arousal index, were calculated. Results: The mean total NOSE scale score was 9.5 (SD = 5.6), indicating a moderate level of nasal obstruction. The mean PNEF was 0.56 L/s (SD = 0.44 L/s). A significant negative correlation was found between PNEF and the total NOSE scale score (Spearman's rho = ‐0.319, p = 0.003). Additionally, PNEF was significantly negatively correlated with the arousal index (Spearman's rho = ‐0.329, p = 0.002). However, no significant correlations were found between PNEF and other polysomnographic parameters. Furthermore, individual NOSE questions and the total NOSE score were not significantly correlated with any polysomnographic parameter. Conclusion: This study demonstrates a link between subjective nasal obstruction and reduced nasal airflow, as indicated by PNEF, in patients with OSA. The association between lower PNEF and a higher arousal index suggests that reduced nasal airflow may contribute to a low arousal threshold phenotype in OSA. Future research should further investigate the complex interplay between nasal obstruction, nasal airflow, and other factors that influence OSA severity and treatment response. © 2025 Elsevier B.V., All rights reserved.