From the Guidelines
Chronic sinusitis can contribute to obstructive sleep apnea (OSA) by causing nasal congestion and obstruction, leading to mouth breathing during sleep and increasing the risk of airway collapse. When the sinuses become chronically inflamed, they can force mouth breathing during sleep, altering the breathing pattern and leading to narrowing of the upper airway, which is the hallmark of OSA. The inflammation from sinusitis can also extend to surrounding tissues, causing swelling that further narrows the airway. Some key points to consider in the treatment of chronic sinusitis that may contribute to OSA include:
- Nasal corticosteroid sprays like fluticasone (50-100 mcg per nostril daily) or mometasone (50 mcg per nostril daily) may help reduce inflammation and improve symptoms 1.
- Saline nasal irrigation (using a neti pot or squeeze bottle twice daily with sterile saline solution) can help clear out mucus and reduce congestion.
- Antibiotics may be prescribed if bacterial infection is present.
- In severe cases, oral steroids like prednisone (typically 20-40 mg daily for 5-7 days) may be prescribed.
- For persistent sinusitis causing OSA, ENT evaluation may be necessary to consider procedures like endoscopic sinus surgery, as suggested by the European Respiratory Journal study 1. Treating the underlying sinusitis can reduce nasal obstruction, improve breathing patterns during sleep, and potentially reduce the severity of sleep apnea. It is essential to note that while there is evidence supporting the link between chronic sinusitis and OSA, the treatment of sinusitis may not completely eliminate OSA symptoms, and further evaluation and treatment by a sleep specialist may be necessary. In terms of specific treatments, intranasal corticosteroids can be recommended as concomitant therapy in patients with mild to moderate OSA and co-existing rhinitis and/or upper airway obstruction due to adenotonsillar hypertrophy 1. However, other treatments such as nasal dilators, nasal surgery as a single intervention, and radiofrequency tonsil reduction are not recommended for reducing snoring, improving sleep disordered breathing, or treating OSA 1. Overall, treating chronic sinusitis can be an essential step in managing OSA symptoms, and a comprehensive treatment plan should be developed in consultation with a healthcare provider.
From the Research
Chronic Sinusitis and Obstructive Sleep Apnea
- Chronic sinusitis is a common disease characterized by sinonasal mucosal inflammation, which can lead to symptoms such as nasal obstruction, facial pressure or pain, and decreased sense of smell 2.
- Nasal obstruction is considered an independent risk factor for obstructive sleep apnea, and treating nasal obstruction with intranasal corticosteroids can improve sleep quality and reduce daytime dysfunction in patients with obstructive sleep apnea 3.
- Chronic rhinosinusitis, which includes chronic sinusitis, is strongly associated with obstructive sleep apnea and can significantly worsen sleep quality, both subjectively and objectively 4.
- The relationship between chronic sinusitis and obstructive sleep apnea is supported by the fact that treating chronic rhinosinusitis surgically can improve subjective sleep scores, suggesting that chronic sinusitis may contribute to the development of obstructive sleep apnea 4.
Mechanisms and Associations
- The exact mechanisms by which chronic sinusitis contributes to obstructive sleep apnea are not fully understood, but it is thought that nasal obstruction and inflammation in the upper airway may play a role 3, 4.
- Chronic sinusitis can cause long-term symptoms, including nasal obstruction, which can lead to sleep disturbances and increase the risk of developing obstructive sleep apnea 2, 5.
- The association between chronic sinusitis and obstructive sleep apnea highlights the importance of managing chronic sinusitis and addressing nasal obstruction to improve sleep quality and reduce the risk of sleep-related disorders 3, 4.