Nose and paranasal sinuses: Edited by James A. DuncavageThe role of the nose in the pathogenesis of obstructive sleep apneaKohler, Malcolma,b; Bloch, Konrad Ea,c; Stradling, John RbAuthor Information aPulmonary Division, University Hospital of Zurich, Switzerland bSleep Unit, Oxford Centre for Respiratory Medicine, UK cCentre for Integrative Human Physiology, University of Zurich, Switzerland Correspondence to Malcolm Kohler, MD, Sleep Unit, Pulmonary Division, University Hospital of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland Tel: +41 44 255 11 11; fax: +41 44 255 44 51; e-mail: Malcolm.Kohler@bluewin.ch Malcolm Kohler is the recipient of a European Respiratory Society (number 114) and University of Zurich research fellowship. Current Opinion in Otolaryngology & Head and Neck Surgery: February 2009 - Volume 17 - Issue 1 - p 33-37 doi: 10.1097/MOO.0b013e32831b9e17 Buy Metrics Abstract Purpose of review To define the relationship between obstructive sleep apnea (OSA) and nasal obstruction, we have reviewed the literature on epidemiological, physiological, and randomized controlled studies in which the relationship between nasal obstruction and OSA was investigated. Recent findings Data from observational studies suggest that nasal obstruction contributes to the pathogenesis of OSA. Recently, studies have mainly focused on the effects of therapeutic interventions on the nose and OSA. Eleven trials with randomized controlled designs were found; external nasal dilators were used in five studies, topically applied steroids in one, nasal decongestants in three, and surgical treatment in two studies. Data from these studies showed only minor improvement in the symptoms and severity of OSA. Summary The current evidence suggests that the nose may not play a significant role in the pathogenesis of OSA. The impact of treating nasal obstruction in patients with OSA on long-term outcome remains to be defined more accurately through randomized controlled trials of medical and surgical therapies with large numbers of patients. © 2009 Lippincott Williams & Wilkins, Inc.