Independent Role of Nasal Congestion in Positive Airway Pressure Compliance for OSA Treatment

Otolaryngol Head Neck Surg. 2022 Aug;167(2):395-402. doi: 10.1177/01945998211064577. Epub 2021 Dec 14.


Objective: To determine the independent role of nasal congestion in positive airway pressure (PAP) therapy compliance and factors associated with an unfavorable shift of PAP compliance.

Study design: Prospective cohort study.

Setting: Tertiary care center.

Methods: This follow-up study comprised 174 patients with newly diagnosed obstructive sleep apnea (OSA) who accepted PAP therapy from January 2017 to June 2019. Information was collected on basic demographics, comorbidities, sleep-related symptoms, nasal symptoms, and upper airway assessment. PAP adherence data were collected at the end of the first week and the third month.

Results: After 3 months of follow-up, 147 participants were included for final data analysis. The proportion of nasal congestion (29.2% vs 52.0%, P = .005) and its severity (mean rank, 58.5 vs 75.1; P = .007) were significantly higher in the noncompliance group as compared with the compliance group. After adjustment for basic demographics, comorbidities, sleep-related symptoms or sleep study parameters, and Friedman clinical staging, multinomial logistic regression models showed that nasal congestion (all odds ratios >2.0, P < .05) was independently associated with a higher odds of PAP noncompliance. Patients with an unfavorable shift of PAP compliance were younger (mean ± SD, 47.5 ± 10.6 vs 53.1 ± 12.6 years; P = .021) and had a lower body mass index (27.2 ± 3.7 vs 29.3 ± 5.0, P = .027) than those who consistently complied. OSA severity was associated with PAP compliance, initially and in the long term.

Conclusion: Nasal congestion is an independent predictor of PAP noncompliance. Younger patients with lower BMI were more likely to have an unfavorable shift of PAP compliance. Initial and long-term adherence to PAP therapy was affected by OSA severity.

Keywords: compliance; nasal congestion; obstructive sleep apnea; positive airway pressure.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Continuous Positive Airway Pressure
  • Follow-Up Studies
  • Humans
  • Nose Diseases*
  • Patient Compliance
  • Polysomnography
  • Prospective Studies
  • Sleep Apnea, Obstructive* / diagnosis