The use of topical nasal steroids to improve continuous positive airway pressure compliance in patients with obstructive sleep apnea: An updated systematic review and meta-analysis of randomized control trials
Charnsiri Segsarnviriya,1 Mantana Prakassajjatham,2 Naricha Chirakalwasan,3,4 Prakobkiat Hirunwiwatkul,4,5 Busarakum Chaitusaney,4,5 Natamon Charakorn4,5
Affiliations:
1 Department of Otorhinolaryngology Head and Neck Surgery, Samitivej Thonburi Hospital, Bangkok, Thailand
2 Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
3 Division of Pulmonary and Critical Care medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
4 Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
5 Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Abstract
Background: Nasal steroids are commonly prescribed to reduce nasal side effects, which are the primary cause of continuous positive airway pressure (CPAP) intolerance in obstructive sleep apnea (OSA) patients.
Objectives: We conducted a systematic review and meta-analysis of OSA patients to assess the effect of nasal steroids on CPAP compliance and nasal symptoms.
Methods: PubMed, Scopus, Ovid, and Cochrane Library were searched through March 2022. Randomized controlled trials (RCTs) evaluating the effects of nasal steroids on CPAP compliance in adult patients, which reported quantitative data on CPAP use and nasal symptoms, were included.
Results: Three RCTs (224 patients) were eligible for the meta-analysis. At the 4-week follow-up, the study did not demonstrate a statistically significant difference in CPAP compliance (average hours of CPAP use per night: mean difference 0.45; 95% confident interval (CI) (-0.01, 0.90); P = 0.06, percentage of nights device used: mean difference 1.79; 95%CI (-2.59, 6.17); P = 0.42). There was also no difference in overall nasal symptoms (mean difference 0.47, 95%CI (-0.00, 0.94); P = 0.05), with significantly more sneezing and rhinorrhea among patients with nasal steroids (sneezing: mean difference 0.64, 95%CI (0.23, 1.05); P = 0.002, rhinorrhea: mean difference 0.78, 95%CI (0.24, 1.31); P = 0.005).
Conclusion: At the 4-week follow-up, the pooled results did not demonstrate significant benefits of nasal steroids on CPAP compliance. There was also no significant benefit for relieving nasal symptoms. To further explore the benefit of nasal steroids on CPAP use, additional, longer-term studies are required.
Key words: Continuous positive airway pressure, Nasal steroid, Steroid, Obstructive sleep apnea, Obstructive sleep apnea syndrome