How obesity affects nasal function in obstructive sleep apnea: anatomic and volumetric parameters

Rodrigues, Marcos Marques; Carvalho, Pedro Henrique de Azambuja; Gabrielli, Mário Francisco Real; Lopes, Ricardo Nasser; Garcia Junior, Otávio Alves; Pereira Filho, Valfrido Antonio; Passeri, Luis Augusto

doi:10.1016/j.bjorl.2020.06.002

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Brazilian Journal of Otorhinolaryngology

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Sumário

Original article • Braz. j. otorhinolaryngol. 88 (3) • May-Jun 2022 • https://doi.org/10.1016/j.bjorl.2020.06.002 copy

How obesity affects nasal function in obstructive sleep apnea: anatomic and volumetric parameters^☆ ☆ Study conducted at Oral and Maxillofacial Surgery Division of the Dental School at Araraquara − Unesp, and from the Otorhinolaryngology Clinics of the Medical School at the University of Araraquara - Uniara, Araraquara, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Obstructive sleep apnea is a consequence of upper airway collapse. Any obstructive sector in the upper airway can contribute to pharyngeal collapse. Obesity and obesity-related disorders play an important role in obstructive sleep apnea and its relationship with increased upper airway resistance.

Objective

This study was designed to evaluate the relationship between obesity and properties of the nasal cavity in patients with obstructive sleep apnea.

Methods

The study was conducted retrospectively by review of medical records of adult patients. The nasal obstruction symptom evaluation, NOSE instrument, was used to measure nasal obstruction. Sleep breathing disorders were evaluated by polysomnography exams. Nasal volume was obtained by computed tomography scans and volumetric reconstruction of nasal airway. Nasal anatomic alterations were assessed by nasal endoscopy.

Results

Analysis of 83 patient records, among whom 54 were male and 29 females, found the mean body mass index of 28.69 kg/m². Obese and non-obese groups were determined by using cut-off 30 kg/m². In the comparison between groups, the obese group had a positive and significant correlation with apnea/hypopnea index (p= 0.02), NOSE instrument (p= 0.033) and inferior turbinate hypertrophy (p= 0.036), with odds ratio 1.983 (95% IC 1.048 − 3.753). nasal septum deviation (p= 0.126) and nasal airway volume evaluation (p= 0.177) showed no significant results.

Conclusion

Obesity was significantly correlated with subjective nasal obstruction, NOSE scale, and inferior turbinate hypertrophy in patients with obstructive sleep apnea. There was no correlation with the nasal volume evaluation.

Level of Evidence

3b - Individual case-control study.

Keywords
Nasal cavity; Obstructive sleep apnea; Nasal obstruction

	BMI	NOSE scale	AHI	Nasal volume
n	83	83	83	83
Mean ± Std. deviation	28.70	39.52	27.94	17.25
Mean ± Std. deviation	4.06	19.67	27.59	4.15
Kolmogorov-Smirnov Z	0.629	2.296	1.64	0.800
p	0.824	0.001	0.009	0.545

	Gender	Mean	Std. deviation	p
NOSE	Male	40.95	20.60	0.935^a a Mann-Whitney test.
NOSE	Female	39.00	16.73	0.935^a a Mann-Whitney test.
AIH	Male	36.18	29.47	0.0001^a a Mann-Whitney test.
AIH	Female	10.24	8.24	0.0001^a a Mann-Whitney test.
Nasal volume	Male	17.97	4.35	0.155^b b Students-t test.
Nasal volume	Female	15.85	3.74	0.155^b b Students-t test.
BMI	Male	29.07	3.90	0.474^b b Students-t test.
BMI	Female	27.97	4.05	0.474^b b Students-t test.

	Obesity group	n	Mean	Std. deviation	Percent	p
NOSE Scale	Non-obese	56	37.11	18.16	−	0.033^a a Mann-Whitney test.
NOSE Scale	Obese	27	44.52	21.99	−	0.033^a a Mann-Whitney test.
AHI	Non-Obese	56	22.47	23.59	−	0.020^a a Mann-Whitney test.
AHI	Obese	27	39.28	32.02	−	0.020^a a Mann-Whitney test.
Nasal volume	Non-Obese	56	16.78	3.85	−	0.177^b b Student’s-t test.
Nasal volume	Obese	27	18.29	4.62	−	0.177^b b Student’s-t test.
ITH ^c c Inferior Turbinate Hypertrophy.	Non-obese	56	−	−	13/56 (23%)	0.036^e e Chi-Square Test.
ITH ^c c Inferior Turbinate Hypertrophy.	Obese	27	−	−	13/27(48%)	0.036^e e Chi-Square Test.
NSD ^d d Nasal Septum Deviation.	Non-obese	56	−	−	29/56 (51%)	0.126^e e Chi-Square Test.
NSD ^d d Nasal Septum Deviation.	Obese	27	−	−	18/27(66%)	0.126^e e Chi-Square Test.

	ITH	Mean	Std. deviation	p
NOSE	Yes	45.86	21.46	0.041^a a Mann-Whitney test.
NOSE	No	37.81	18.38	0.041^a a Mann-Whitney test.
AIH	Yes	33.93	31.42	0.051^a a Mann-Whitney test.
AIH	No	23.10	24.65	0.051^a a Mann-Whitney test.
Nasal volume	Yes	17.09	5.08	0.198^b b Student’s-t test.
Nasal volume	No	17.36	3.98	0.198^b b Student’s-t test.
BMI	Yes	29.70	3.49	0.044^b b Student’s-t test.
BMI	No	27.96	3.94	0.044^b b Student’s-t test.

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

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[1] ⁎Corresponding author. E-mail:carvalhopha@outlook.com (P.H. Carvalho).