It is anecdotally well known that patients snore more when their nose is blocked. However,
the therapeutic effect of improving nasal airway patency on snoring indices remains a point
of conjecture. Indeed, Braver et al examined the effect of a nasal vasoconstrictor and failed
to show any improvement in the number of snores after its application, although
apnoea-hypopnoea index (AHI)seemed to decrease. Furthermore, Hoffstein et al documented that
dilation of the anterior nares in patients without nasal pathology has a relatively weak
effect on snoring, and routine use of nasal dilating appliances was not recommended for the
treatment of snoring. In contrast to the aforementioned studies, intranasal corticosteroids
have been shown to improve sleepiness and reduce AHI in patients with obstructive sleep apnea
(OSA) implying that there might be an equivalent result for the use of nasal steroids on
snoring indices.
Additionally, the present authors have demonstrated a strong correlation between
apnoea-hypopnoea index and oral/oro-nasal breathing epochs in patients with OSA and normal
nasal resistance and that nasal surgery is effective only in OSA patients who preoperatively
have decreased nasal breathing epochs.
It is plausible thus to suggest that snoring severity, in equivalence to OSA severity, might
be associated to oral/oro-nasal breathing epochs and that improving nasal patency by nasal
steroids might also increase nasal breathing epochs and lead to decreased snoring indices in
patients who had decreased nasal breathing before the administration of nasal steroids.
Patients will be randomized in two groups: the patients of the first group will undergo a one
week therapy of nasal budesonide, then two weeks of washout period, and thereafter one week
of nasal normal saline. The patients of the second group will undergo a one week therapy of
nasal normal saline, then two weeks of washout period, and thereafter one week of nasal
budesonide. Before and after each treatment regimen patients will undergo an assessment,
which will consist of anterior rhinomanometry and polysomnography with concomitant
measurement of snoring indices and breathing route pattern.
The investigators hypothesize that the application for one week of nasal budesonide has a
beneficial effect on snoring indices in patients who present before the application decreased
proportion of nasal breathing epochs and in whom nasal budesonide succeeded in increasing
nasal breathing epochs.