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 apnoe
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Anne-Lise Poirrier, Philippe Eloy, and Philippe Rombaux
Keywords
Sleep-disordered breathing • SDB • Snoring • OSA • Nasal obstruction • Physiopathology of nose obstruction and SDB • Treatment of nasal obstruction • Nasal collapse • Polysomnography
Core Messages A.-L. Poirrier, MD, PhD (*) Department of Otolaryngology, CHU-Liège, ULG, Sart-Tilman B35, Liège 4000, Belgium e-mail: [email protected] Ph. Eloy, MD HNS & ENT Department, CHU-Mont-Godinne, UCL, Avenue Thérasse 1, Yvoir 5530, Belgium Department of Otorhinolaryngology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, Brussels, Belgium Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium e-mail: [email protected] Ph. Rombaux, MD, PhD HNS & ENT department, Cliniques Universitaires Saint Luc, Avenue Hippocrate, 12, Brussels 1200, Belgium Department of Otorhinolaryngology, Cliniques Universitaires Saint Luc, Avenue Hippocrate 10, Brussels, Belgium Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium e-mail: [email protected]
• The nose is the input channel for the airflow. Its rigid and erectile structures determine the outline and the output of the airflow in the upper airway. Nose obstruction, due to reversible or nonreversible factors, produces collapsing forces that are manifest downstream in the collapsible pharynx. Moreover, nose pathologies result in unstable oral breathing, decreased activation of nasalventilatory reflex and reduced lung nitric oxide. Long-term oral breathing impacts on the craniofacial growth. The management of nose pathologies could be medical, mechanical (nose dilators) or surgical. Nasal management should be integrated in a multimodal approach, considering the involvement of a multilevel obstruction, and truly reflecting the complexity of sleep disordered breathing.
T.M. Önerci (ed.), Nasal Physiology and Pathophysiology of Nasal Disorders, DOI 10.1007/978-3-642-37250-6_23, © Springer-Verlag Berlin Heidelberg 2013
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Introduction
Sleep-disordered breathing (SDB) is a clinical entity that is more and more recognised by physicians since the 1970s. It consists of a wide spectrum of sleep-related breathing abnormalities. Those related to increased upper airway resistance include snoring, upper airway resistance syndrome (UARS) and obstructive sleep apnoea-hypopnoea syndrome (OSAHS) (Young et al. 1993). Snoring is associated with changes in the calibre of the upper airway which reduce flow and increase airway resistance and is a manifestation of increased turbulence in nasal flow (Phillipson 1993; Pirsig 2003). UARS is caused by sleeprelated flow limitation and increase in upper airway resistance that precipitates arousals. UARS results in fragmented sleep and excessive daytime sleepiness. Obstructive sleep apnoea (OSA) syndrome is the complete or partial collapse of breathing despite ongoing respiratory effort. In patients with OSA, recurrent obstruction of the pharynx during sleep results in frequent episod
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