What is the role of nasal dilators in treating snoring?

Nasal Dilators for Snoring Treatment

Nasal dilators are not recommended for treating snoring based on the highest quality guideline evidence, which found insufficient data to support their effectiveness in reducing snoring or improving sleep outcomes.

Guideline-Based Recommendation

The European Respiratory Society explicitly states that nasal dilators are not recommended for reducing snoring, or for improving sleep disordered breathing or sleep architecture in obstructive sleep apnea (Grade D recommendation) 1. This recommendation applies to both external nasal dilators (like nasal strips) and internal nasal dilators 1.

Evidence Summary

Physiological Effects vs. Clinical Outcomes

While nasal dilators do produce measurable physiological changes, these do not translate into meaningful clinical benefits:

• Nasal dilation increases nasal cross-section by 14-25% and reduces nasal resistance by 31-65% 1
• However, these anatomical improvements do not consistently reduce snoring intensity or frequency 1

External Nasal Dilators (Nasal Strips)

The evidence for external nasal dilators shows inconsistent and limited benefits:

• One study showed reduction in maximum snoring intensity, while another study showed no effect on snoring at all 1
• Sleep architecture remains essentially unchanged in habitual snorers 1
• External nasal dilators are well-tolerated but lack proven efficacy 1

Internal Nasal Dilators

Internal devices show similarly disappointing results:

• Internal nasal dilators have only a weak effect on snoring in patients without nasal pathology 1
• They have little or no effect on apneas, hypopneas, oxygen saturation, or daytime sleepiness 1
• Even when snoring noise decreases, there is no improvement in sleep-disordered breathing parameters 1

Potential Exceptions (Limited Evidence)

There may be specific subgroups where nasal dilators could have marginal benefit, though this remains unproven:

• Patients with specific anatomical features such as turbinate hypertrophy, septal deviation, allergic rhinitis, minimal pharyngeal obstruction, or age <55 years might respond better 1
• Patients with documented nasal obstruction as the primary cause of snoring 1

Quality of Supporting Evidence

The guideline recommendation is based on a comprehensive review:

• 14 studies were identified (only 2 randomized controlled trials, 12 other clinical trials) published between 1988-2005 1
• The limited number of high-quality randomized trials and the age of the evidence strengthen the case against routine use 1

Alternative Evidence-Based Approaches

Instead of nasal dilators, consider these interventions with stronger evidence:

• Weight reduction for overweight patients should be the first-line approach 2, 3
• Mandibular advancement devices (MADs) have the highest level of evidence (Grade A) for mild to moderate OSA 2
• CPAP therapy remains the gold standard for obstructive sleep apnea 4

Clinical Pitfalls to Avoid

• Do not recommend nasal dilators as a primary treatment for snoring, even though they are readily available over-the-counter 1
• Avoid assuming that improved nasal airflow automatically translates to reduced snoring—the evidence does not support this assumption 1
• Do not delay evaluation for obstructive sleep apnea by trialing ineffective nasal dilators 1