Improvement of CPAP tolerance and adherence in a patient with obstructive sleep apnea with the use of nasal steroids and nasal oxymetazoline.

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.