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Influence of Intranasal Corticosteroids on Sleep Parameters and Airway Inflammation

Objective: Fatigue is associated with obstructive sleep apnea (OSA). Increased inflammation in the pharyngeal tissues of OSA patients may further exacerbate the disease. This study evaluates the effects of intranasal corticosteroid (INCS) treatment on sleep parameters and airway inflammation in AR vs non-AR OSA patients. Method: Allergic rhinitis (34), non-AR (21) received mometasone. Before and after treatment, patients underwent polysomnography, MWT, Epworth assessment, and tissue biopsies from the turbinate, nasopharynx, uvula. The biopsies were processed for EG2, CD4, CD8, macrophages and neutrophils. Results: There were no differences in age, sex, BMI, or apnea-hypopnea index (mean AHI = 28.4 vs 27.7/h) at baseline. After treatment, AR group showed significant improvements in: 1) supine AHI (55.85 vs 39.7/h), 2) oxygen saturation nadir (86.42 vs 88.8%), and 3) Epworth scores. This improvement was associated with reduction of eosinophils (P < .0001), and to lesser extend CD4 positive cells (P < .05) in the tissue obtained from the 3 sites, CD68 decreased at the uvula. Allergic subjects had a higher nasal symptoms score before treatment, not statistically significant, nor was there evidence that change over time differed by allergy status. Conclusion: This study confirmed the implication of inflammation in sleep apnea and showed that controlling inflammation in the upper airways is very useful in improving clinical symptoms associated with this disease.