Nasal Strips Are Not Effective for OSA or Snoring
Nasal dilators (both external strips like Breathe Right and internal devices like NoZovent) are not recommended for treating obstructive sleep apnea or reducing snoring, as they have failed to demonstrate meaningful improvements in sleep-disordered breathing or clinical outcomes. 1
Guideline Recommendations
The European Respiratory Society provides a Grade D recommendation (lowest level) explicitly stating that nasal dilators should not be used for:
- Reducing snoring 1
- Improving sleep-disordered breathing in OSA 1
- Improving sleep architecture in OSA 1
Evidence Summary
External Nasal Dilators (Breathe Right Strips)
Physiologic effects without clinical benefit:
Clinical outcomes are disappointing:
- Mixed results on snoring: reduced maximum snoring intensity in one study but had no effect in another 1
- Sleep architecture remains essentially unchanged in habitual snorers and shows only slight improvement in OSA patients 1
- OSA severity improved in only one small study (10 patients with OSA and nasal obstruction) but failed to show benefit in a larger study (30 patients) 1
- No additional effect on sleep-disordered breathing in upper airway resistance syndrome (18 patients studied) 1
Internal Nasal Dilators (NoZovent)
More pronounced physiologic changes but still clinically ineffective:
- Reduce nasal resistance by 31-65% 1
- Weak effect on snoring in patients without nasal pathology 1
- Substantial decrease in snoring noise in patients with habitual snoring and/or OSA, but this is subjective 1
- Little to no effect on apneas, hypopneas, oxygen saturation, or daytime hypersomnolence 1
Meta-Analysis Findings
A 2016 systematic review and meta-analysis of 147 patients found: 2
- No significant change in apnea-hypopnea index (AHI): 28.7 ± 24.0 to 27.4 ± 23.3 events/hr (p=0.64) 2
- No improvement in lowest oxygen saturation 2
- No improvement in snoring index 2
- Subanalysis showed minimal benefit: internal dilators decreased apnea index by 4.87 events/hr, while external dilators actually increased it by 0.64 events/hr 2
Confirmatory Study
A 1997 controlled study of 50 patients (30 with OSA, 20 snorers without OSA) found: 3
- No change in apnea index, desaturation index, or oxygen saturation in OSA patients 3
- No change in snoring frequency in non-OSA snorers 3
- Patients reported improved nasal breathing subjectively, but this did not translate to objective improvements 3
Potential Predictors of Response (Unproven)
The guidelines suggest possible parameters that might predict efficacy, though evidence is insufficient: 1
- Hyperplasia or hypertrophy of lower turbinates
- Septal deviation
- Allergic rhinitis
- Minimal or no pharyngeal obstruction
- Age <55 years
Critical caveat: Even if these factors are present, the overall evidence does not support routine use of nasal dilators.
What Actually Works
- CPAP remains the gold standard
- Mandibular advancement devices for mild-to-moderate OSA (Grade A recommendation)
- Weight reduction for overweight/obese patients
- Maxillomandibular osteotomy in selected cases
For isolated snoring: 5
- Laser-assisted uvulopalatoplasty (LAUP) is less invasive and better tolerated than uvulopalatopharyngoplasty (UPPP)
For nasal obstruction contributing to OSA: 6
- Medical management (topical nasal steroids) improves CPAP compliance and daytime sleepiness
- Surgical correction of structural nasal obstruction improves CPAP adherence but has minimal effect on OSA severity itself
Bottom Line
Despite improving nasal airflow objectively and patients reporting better nasal breathing, nasal dilators fail to address the fundamental pathophysiology of OSA, which occurs primarily at the pharyngeal level, not the nasal vestibule. 1, 2 The disconnect between improved nasal patency and lack of clinical benefit demonstrates that nasal resistance is not the primary driver of OSA or snoring in most patients.