Chest
Volume 90, Issue 3, September 1986, Pages 324-329
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Clinical Investigations
Effect of Intranasal Obstruction on Breathing during Sleep

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While nasal mucosal stimulation in animals has been reported to produce central apneas and while nasal packing in humans is known to produce sleep-disordered breathing, it is controversial whether intranasal obstruction in humans produces predominantly central or obstructive apnea. To answer this question, we studied eight normal men by having them sleep in random order with their nose open or occluded with petrolatum gauze. Esophageal pressure was measured to detect respiratory effort, and standard techniques were used to monitor and score the stages of sleep. Intranasal occlusion increased both the number of apneas plus hypopneas per hour of sleep and the minutes of obstructive events per hour of sleep (p<0.05). The minutes of central events per hour of sleep also increased significantly but not to the degree that occurred with obstructive events. Nasal obstruction produced no immediate changes in pulmonary function. The subject with the highest resistance measured through the mouth with the pulse flow method had the most apneas following nasal occlusion. We conclude that intranasal obstruction produces predominantly obstructive apneas and hypopneas during sleep.

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Subjects

We studied eight normal male volunteers during sleep and eight during wakefulness after obtaining written informed consent. Seven of the eight subjects studied during wakefulness were different individuals than those studied during sleep. None of the subjects was obese or complained of difficulty in sleeping as determined from a standardized sleep questionnaire. Anthropomorphic characteristics of subjects are listed in Table 1.

Intranasal occlusion was accomplished by inserting strips of gauze

RESULTS

On the unoccluded night, all subjects had a few apneas or hypopneas, and one each had 10.8 and 14 apneas plus hypopneas per hour (Fig 1). Intranasal occlusion significantly increased the hourly rate of apneas, of hypopneas, and of apneas plus hypopneas, as well as the mean duration of apneas and hypopneas (Figure 1, Figure 2) (p<0.05). Intranasal occlusion had no significant effect on the desaturations per hour or the average desaturation, although the desaturation per hour increased in five of

DISCUSSION

This study demonstrates that intranasal occlusion in normal volunteers markedly increases the number of obstructive apneas and hypopneas during sleep. The number of central events also increased but only slightly. While oxyhemoglobin saturation decreased slightly during the episodes, the decreases were not significant. Intranasal occlusion produced no immediate change in spirometric data, Raw, or oxyhemoglobin saturation. The subject who developed the most apneas following nasal occlusion had

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Sponsored by grants HL 30218 and RR 00847 from the National Institutes of Health.

Manuscript received January 24; revision accepted March 27.

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