Association of Allergic Rhinitis With Change in Nasal Congestion in New Continuous Positive Airway Pressure Users
Open accessAbstract
Importance: Nasal congestion occurring after continuous positive airway pressure (CPAP) treatment initiation impairs CPAP adherence. Allergic rhinitis is associated with worsening nasal congestion in patients who are exposed to nonallergic triggers. Use of CPAP presents potential nonallergic triggers (eg, humidity, temperature, pressure, and airflow). Objective: To compare nasal congestion among CPAP users with allergic rhinitis, nonallergic rhinitis, and no rhinitis. We hypothesize that CPAP patients with baseline allergic rhinitis are more likely to experience a worsening of nasal congestion (or less improvement in nasal congestion) compared with patients with no baseline rhinitis. Design, Setting, and Participants: This prospective cohort study included consecutive patients newly diagnosed with obstructive sleep apnea in a tertiary sleep center who were using CPAP therapy 3 months after diagnosis. Baseline rhinitis status was assigned as allergic rhinitis, nonallergic rhinitis, or no rhinitis, based on questionnaire responses and past allergy testing. Data were collected from 2004 to 2008 and analyzed from July 2019 to February 2020. Main Outcomes and Measures: At baseline before CPAP exposure and again 3 months later, subjective nasal congestion was measured with the Nasal Obstruction Symptom Evaluation (NOSE) scale and a visual analog scale (VAS), each scored from 0 to 100 (100 = worst congestion). Changes in nasal congestion were tested over 3 months for the whole cohort, within each rhinitis subgroup (paired t test), and between rhinitis subgroups (multivariate linear regression). Results: The study cohort comprised 102 participants, of whom 61 (60%) were male and the mean (SD) age was 50 (13). The study included 23 (22.5%) participants with allergic rhinitis, 67 (65.7%) with nonallergic rhinitis, and 12 (11.8%) with no rhinitis. Nasal congestion improved from baseline to 3 months in the whole cohort (mean [SD] NOSE score, 38 [26] to 27 [23], mean [SD] change, -10 [23]; 95% CI, -15 to -6; mean [SD] VAS score, 41 [27] to 32 [28]; mean [SD] change, -10 [26]; 95% CI, [-15 to -4]) and in each rhinitis subgroup. Adjusted improvement in nasal congestion at 3 months was significantly less in the allergic rhinitis subgroup compared with the no rhinitis subgroup (positive difference means less improvement) compared with baseline: NOSE score 14 (95% CI, 1 to 28) and VAS score 15 (95% CI, 0 to 30). Conclusions and Relevance: Initiation of CPAP was associated with improved subjective nasal congestion, but less improvement in patients with baseline allergic rhinitis. Baseline allergic rhinitis may predict which patients are more vulnerable to potential congestive effects of CPAP.
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One cohort study found CPAP users with baseline allergic rhinitis have less improvement in nasal obstruction than those without allergic rhinitis.
“One cohort study found that CPAP users with baseline AR have less improvement in nasal obstruction than those without AR.1174”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [1174]
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- Authors
- Skirko, J. R., James, K. T., Shusterman, D. J., & Weaver, E. M.
- Affiliations
- University of Utah (US)
- University of Washington (US)
- University of California, San Francisco (US)
- Corresponding author
- Skirko, Jonathan R.
- Venue
- JAMA Otolaryngology–Head & Neck Surgery
- Publisher
- American Medical Association (AMA)
- Published
- 2020-06-01
- Volume
- 146
- Issue
- 6
- Pages
- 523
- ISSN
- 2168-6181 (ISSN-L)
- PMC
- PMC7146531
- OpenAlex
- W3015961580
- Semantic Scholar
- fd1335a78f81be012a4defd26c7aa7485d0133cf
- Cited by
- 14
- References
- 29
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 2 · 2023: 4 · 2022: 3 · 2021: 1 · 2020: 1
- FWCI
- 1.35
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Otolaryngology–Head & Neck Surgery (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Veterans Affairs
- National Institutes of Health
- National Heart, Lung, and Blood Institute (R01HL084139, K23HL068849)
- National Institute on Deafness and Other Communication Disorders (T32DC000018)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Immunology and Allergy › Allergic Rhinitis and Sensitization
- Health Sciences › Medicine › Surgery › Nasal Surgery and Airway Studies
- Keywords
- allergic rhinitis, nasal congestion, continuous positive airway pressure, obstructive sleep apnea, CPAP adherence, non-allergic rhinitis, nasal obstruction, Nasal Obstruction Symptom Evaluation, CPAP side effects
- MeSH terms
- Female, Humans, Male, Middle Aged, Prospective Studies, Rhinitis, Nasal Obstruction, Disease Progression, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure, Rhinitis, Allergic
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