Document Detail

Nasal cytology: a marker of clinically silent inflammation in patients with obstructive sleep apnea and a predictor of noncompliance with nasal CPAP therapy.
MedLine Citation:
PMID:  17566187     Owner:  NLM     Status:  MEDLINE    
STUDY OBJECTIVES: Patients with obstructive sleep apnea treated with nasal continuous positive airway pressure (CPAP) often complain of nasal side effects. We studied patients before and after initiation of nasal CPAP to see how treatment affected nasal function and markers of nasal inflammation. We searched for pretreatment findings that might help to predict noncompliance. METHODS: Nasal symptom scores, nasal flow by anterior rhinomanometry, mediator levels (intercellular adhesion molecule-1, interleukin-6, interleukin-8 and interleukin-13), and nasal scrapes for cytology were obtained at baseline and monthly for up to 3 months of nasal CPAP therapy. Compliance was assessed from the patient's report and by recording hours of usage for up to 19 months of follow-up. RESULTS: Thirty-eight patients with newly diagnosed obstructive sleep apnea were classified as having no rhinitis (42%), allergic rhinitis (37%), or nonallergic rhinitis (21%). There was no significant difference in compliance in patients with and without rhinitis. Compliant and noncompliant patients showed no significant differences in their baseline nasal symptom scores, nasal flow, and mediator levels. Nasal neutrophil counts before treatment were greater in noncompliant than in compliant patients (p = .004) and greater in those discontinuing because of nasal symptoms than in patients who quit for other reasons (p = .05). There was a positive correlation between neutrophil counts and nasal bacterial scores, both before and after treatment with nasal CPAP. CONCLUSIONS: Patients with increased neutrophil counts in the nasal scrape before beginning nasal CPAP are at increased risk of discontinuing therapy. They appear to have subclinical nasal inflammation that cannot be identified from clinical assessment, nasal symptom scores or rhinomanometry.
Farhad F Shadan; Alfredo A Jalowayski; John Fahrenholz; Lawrence E Kline; Arthur Dawson
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine     Volume:  1     ISSN:  1550-9389     ISO Abbreviation:  -     Publication Date:  2005 Jul 
Date Detail:
Created Date:  2007-06-13     Completed Date:  2007-07-26     Revised Date:  2007-12-03    
Medline Journal Info:
Nlm Unique ID:  101231977     Medline TA:  J Clin Sleep Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  266-70     Citation Subset:  IM    
Scripps Clinic Sleep Center, La Jolla, CA 92037-1027, USA.
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MeSH Terms
Aged, 80 and over
Biological Markers
Continuous Positive Airway Pressure / methods*
Enzyme-Linked Immunosorbent Assay
Intercellular Adhesion Molecule-1 / immunology,  metabolism
Interleukin-13 / immunology,  metabolism
Interleukin-6 / immunology,  metabolism
Interleukin-8 / immunology,  metabolism
Middle Aged
Nasal Cavity / cytology*,  immunology*,  metabolism
Neutrophils / immunology,  metabolism
Predictive Value of Tests
Rhinitis / epidemiology,  immunology,  metabolism
Sleep Apnea, Obstructive* / diagnosis,  immunology,  therapy
Treatment Refusal / statistics & numerical data*
Grant Support
Reg. No./Substance:
0/Biological Markers; 0/Interleukin-13; 0/Interleukin-6; 0/Interleukin-8; 126547-89-5/Intercellular Adhesion Molecule-1

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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