{"title":"Improvement of CPAP tolerance and adherence in a patient with obstructive sleep apnea with the use of nasal steroids and nasal oxymetazoline.","authors":"Akudo Anokwute, Shalini Manchanda, Paul M Wallach","doi":"10.5664/jcsm.11454","DOIUrl":null,"url":null,"abstract":"<p><p>Adherence to positive airway pressure (PAP) therapy is a challenge in patients with allergic rhinitis. We present a case of a 62-year-old male with OSA who had been struggling with PAP therapy for ten years. Intranasal fluticasone alone did not result in tolerance of PAP therapy. However, the combination of once- daily intranasal oxymetazoline with fluticasone led to significant improvement in tolerance and adherence to PAP therapy. While twice daily oxymetazoline alone has been associated with developing rhinitis medicamentosa, this side effect was not experienced by our patient. Some studies have shown that using intranasal oxymetazoline along with an intranasal steroid once daily for four weeks demonstrated improved effectiveness in relieving nasal symptoms with no development of rebound congestion or rhinitis medicamentosa. This strategy may be helpful in improving CPAP tolerance for patients with concurrent OSA and rhinitis, a potential area to explore in the future to improve PAP adherence.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":null,"pages":null},"PeriodicalIF":3.5000,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Sleep Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5664/jcsm.11454","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Adherence to positive airway pressure (PAP) therapy is a challenge in patients with allergic rhinitis. We present a case of a 62-year-old male with OSA who had been struggling with PAP therapy for ten years. Intranasal fluticasone alone did not result in tolerance of PAP therapy. However, the combination of once- daily intranasal oxymetazoline with fluticasone led to significant improvement in tolerance and adherence to PAP therapy. While twice daily oxymetazoline alone has been associated with developing rhinitis medicamentosa, this side effect was not experienced by our patient. Some studies have shown that using intranasal oxymetazoline along with an intranasal steroid once daily for four weeks demonstrated improved effectiveness in relieving nasal symptoms with no development of rebound congestion or rhinitis medicamentosa. This strategy may be helpful in improving CPAP tolerance for patients with concurrent OSA and rhinitis, a potential area to explore in the future to improve PAP adherence.
过敏性鼻炎患者坚持气道正压疗法(PAP)是一项挑战。我们介绍了一例患有 OSA 的 62 岁男性患者的病例,他十年来一直在与气道正压疗法作斗争。单用氟替卡松鼻内注射并不能使患者耐受 PAP 治疗。然而,每日一次鼻内注射奥昔美唑啉与氟替卡松联合使用后,患者对 PAP 治疗的耐受性和依从性显著提高。虽然每天两次单独使用奥美沙唑啉可能会导致药物性鼻炎,但我们的患者并没有出现这种副作用。一些研究表明,在连续四周每天一次使用鼻内奥美沙唑啉和鼻内类固醇的情况下,缓解鼻部症状的效果有所改善,而且不会出现反弹性鼻塞或鼻炎。这一策略可能有助于改善同时患有 OSA 和鼻炎的患者对 CPAP 的耐受性,这也是未来改善 PAP 依从性的一个潜在探索领域。
期刊介绍:
Journal of Clinical Sleep Medicine focuses on clinical sleep medicine. Its emphasis is publication of papers with direct applicability and/or relevance to the clinical practice of sleep medicine. This includes clinical trials, clinical reviews, clinical commentary and debate, medical economic/practice perspectives, case series and novel/interesting case reports. In addition, the journal will publish proceedings from conferences, workshops and symposia sponsored by the American Academy of Sleep Medicine or other organizations related to improving the practice of sleep medicine.