A pilot evaluation of a nasal expiratory resistance device for the treatment of obstructive sleep apnea
Ian M Colrain, Stephen Brooks, Jed Black, Ian M Colrain, Stephen Brooks, Jed Black
Abstract
Background: Obstructive sleep apnea (OSA) is a major problem in need of new treatment approaches. The present pilot study tests the hypothesis that the application of expiratory resistance via a nasal valve device would improve breathing during sleep in subjects with OSA and in primary snorers.
Methods: Thirty men and women were recruited from the community and from the Stanford University Sleep Disorders Clinic. Twenty-four had at least mild OSA (AHI >5), and 6 were primary snorers. Subjects underwent 2 nights of polysomnographic evaluation, one with and one without a new nasal resistance device with the order of nights counterbalanced across participants. The device consisted of a small valve inserted into each nostril calibrated to provide negligible inspiratory resistance, but increased expiratory resistance with a back pressure between 60 and 90 cm H2O*sec/Liter (at 100 mL/sec flow). Standard polysomnography was conducted to compare participants' sleep both with and without the device, with the scoring conducted blind to treatment condition.
Results: The apnea-hypopnea (AHI) (p < 0.001) and oxygen desaturation (O2DI) (p < 0.01) indices both significantly decreased, and the percentage of the night spent above 90% saturation (p < 0.05) significantly increased with device use. The observed amount of snoring (p < 0.001) was significantly decreased with device use, and there were no significant changes in measures of sleep architecture.
Conclusions: The results of this pilot study are suggestive of a therapeutic effect of expiratory nasal resistance for some OSA patients and indicate that this technique is worthy of further clinical study.
Figures
![Figure 1](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/2576328/bin/jcsm.4.5.426a.jpg)
![Figure 2](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/2576328/bin/jcsm.4.5.426b.jpg)
Figure 3
Histogram of the oxygen desaturation…
Figure 3
Histogram of the oxygen desaturation index shown on treatment and control nights for…
- A multicenter, prospective study of a novel nasal EPAP device in the treatment of obstructive sleep apnea: efficacy and 30-day adherence.Rosenthal L, Massie CA, Dolan DC, Loomas B, Kram J, Hart RW. Rosenthal L, et al. J Clin Sleep Med. 2009 Dec 15;5(6):532-7. J Clin Sleep Med. 2009. PMID: 20465019 Free PMC article. Clinical Trial.
- Long-term use of a nasal expiratory positive airway pressure (EPAP) device as a treatment for obstructive sleep apnea (OSA).Kryger MH, Berry RB, Massie CA. Kryger MH, et al. J Clin Sleep Med. 2011 Oct 15;7(5):449-53B. doi: 10.5664/JCSM.1304. J Clin Sleep Med. 2011. PMID: 22003339 Free PMC article. Clinical Trial.
- Predictors of response to a nasal expiratory resistor device and its potential mechanisms of action for treatment of obstructive sleep apnea.Patel AV, Hwang D, Masdeu MJ, Chen GM, Rapoport DM, Ayappa I. Patel AV, et al. J Clin Sleep Med. 2011 Feb 15;7(1):13-22. J Clin Sleep Med. 2011. PMID: 21344051 Free PMC article. Clinical Trial.
- Role of nasal positive end expiratory pressure valve as an alternative treatment for obstructive sleep apnoea in Chinese patients.To KW, Chan TO, Ng S, Ngai J, Hui DS. To KW, et al. Respirology. 2016 Apr;21(3):541-5. doi: 10.1111/resp.12703. Epub 2015 Dec 6. Respirology. 2016. PMID: 26640077
- A mandibular protruding device in obstructive sleep apnea and snoring.Fransson A. Fransson A. Swed Dent J Suppl. 2003;(163):1-49. Swed Dent J Suppl. 2003. PMID: 14713187 Review.
- Making Sense of the Noise: Toward Rational Treatment for Obstructive Sleep Apnea.Kezirian EJ, Simmons M, Schwab RJ, Cistulli P, Li KK, Weaver EM, Goldberg AN, Malhotra A. Kezirian EJ, et al. Am J Respir Crit Care Med. 2020 Dec 1;202(11):1503-1508. doi: 10.1164/rccm.202005-1939PP. Am J Respir Crit Care Med. 2020. PMID: 32697596 Free PMC article. No abstract available.
- Internal nasal dilator in patients with obstructive sleep apnea.Gelardi M, Intiglietta P, Porro G, Quaranta VN, Resta O, Quaranta N, Ciprandi G. Gelardi M, et al. Acta Biomed. 2019 Jan 11;90(2-S):19-23. doi: 10.23750/abm.v90i2-S.8099. Acta Biomed. 2019. PMID: 30715033 Free PMC article.
- Nasal Expiratory Positive Airway Pressure Devices (Provent) for OSA: A Systematic Review and Meta-Analysis.Riaz M, Certal V, Nigam G, Abdullatif J, Zaghi S, Kushida CA, Camacho M. Riaz M, et al. Sleep Disord. 2015;2015:734798. doi: 10.1155/2015/734798. Epub 2015 Dec 21. Sleep Disord. 2015. PMID: 26798519 Free PMC article. Review.
- Innovative treatments for adults with obstructive sleep apnea.Weaver TE, Calik MW, Farabi SS, Fink AM, Galang-Boquiren MT, Kapella MC, Prasad B, Carley DW. Weaver TE, et al. Nat Sci Sleep. 2014 Nov 18;6:137-47. doi: 10.2147/NSS.S46818. eCollection 2014. Nat Sci Sleep. 2014. PMID: 25429246 Free PMC article. Review.
- A review of EPAP nasal device therapy for obstructive sleep apnea syndrome.Wu H, Yuan X, Zhan X, Li L, Wei Y. Wu H, et al. Sleep Breath. 2015 Sep;19(3):769-74. doi: 10.1007/s11325-014-1057-y. Epub 2014 Sep 23. Sleep Breath. 2015. PMID: 25245174 Review.
- Research Support, Non-U.S. Gov't
- Adult
- Aged
- Air Pressure
- Airway Resistance*
- Continuous Positive Airway Pressure / instrumentation
- Equipment Design
- Exhalation*
- Female
- Humans
- Male
- Middle Aged
- Oxygen / blood
- Pilot Projects
- Polysomnography
- Respiratory Therapy / instrumentation*
- Sleep Apnea, Obstructive / therapy*
- Snoring / therapy
- Treatment Outcome
- Young Adult
- Oxygen
- Full Text Sources
- Other Literature Sources
- Medical
![Figure 3](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/2576328/bin/jcsm.4.5.426c.jpg)
Source: PubMed