This study was designed to investigate the prevalence of bronchial hyperreactivity (BH) in patients with obstructive sleep apnea syndrome (OSAS), heavy snorers, and light snorers; its correlation with OSAS severity; and its response to nasal CPAP therapy. Forty-eight age- and sex-matched subjects were selected on the basis of preentry sleep studies: Group I consisted of 16 patients with OSAS (hypopnea-apnea index (HAI) = 35 +/- 9); group II consisted of 16 cases of heavy snorers without OSAS; and group III, a control group, consisted of 16 subjects with only mild snoring. All 48 patients had normal pulmonary function (simple spirometry) prior to study entry and had no history of asthma or allergies. The prevalence of BH was prospectively assessed by giving each subject a methacholine challenge test (MCT). Patients with a positive MCT were treated with 2-3 months of nasal CPAP treatment, after which they had a second MCT. Four of 16 patients in group I had BH on MCT (PD20 = 88, 103, 109, 162 D.U.), whereas none of the group II or III subjects demonstrated BH. There was no correlation between BH and the severity of the OSAS. The 4 patients with BH in group I showed an increase in PD20M after 2-3 months of nasal CPAP treatment. In conclusion, BH may occur in patients with OSAS. It is unrelated to the severity of the OSAS, and nasal constant positive airway pressure (CPAP) therapy can decrease the hyperreactivity to methacholine in these patients.