Managing OSA and Non-Allergic Rhinitis: Treatment Options and Considerations

Obstructive Sleep Apnea (OSA) and Rhinitis Issues

Hello, doctor.
Recently, I have been experiencing significant stress due to work, leading to anxiety and worry.
After a period of consultation with a physician, it was determined that my issues may primarily stem from Obstructive Sleep Apnea (OSA) – I have a polysomnography (PSG) scheduled but have not yet been able to undergo it – and nasal allergy problems, which I have had for over 20 years.
The recent autumn and winter weather, along with significant temperature fluctuations, have exacerbated these issues.
For a long time, I have felt that no matter how early I go to bed, I do not feel well-rested in the morning.
Recently, with added psychological stress, I have been feeling fatigued and drowsy at work, unable to concentrate, and experiencing dizziness.
A 30-minute nap at noon significantly improves my energy levels in the afternoon and alleviates the dizziness.
The doctor has prescribed antihistamines (Loratadine and Pseudoephedrine), anxiolytics (Lexotan 1.5 mg), and a medication for autonomic nervous system regulation (Propranolol), which was prescribed by different physicians.
However, I feel that these treatments have not significantly alleviated my symptoms.
Upon self-evaluation, I have noticed that my allergy symptoms typically flare up during significant temperature changes, such as when it shifts from cold to hot or vice versa, or when air quality worsens due to dust or smoke.
I experience nasal congestion and a slight runny nose, but my biggest concern is the rapid onset of dizziness and drowsiness, along with decreased cognitive focus.
Sometimes, when stress arises, I immediately feel dizzy and sleepy.
Since the ENT clinic did not provide detailed inquiries, I researched online and learned about non-allergic rhinitis, specifically vasomotor rhinitis, which cannot be cured due to the absence of allergens.
I also found that for OSA, uvulopalatopharyngoplasty (UPPP) and a snoring appliance are recommended, while for vasomotor rhinitis, a procedure involving the neuroablation of the nasal turbinates is suggested.
However, it seems challenging to find a physician who can perform both procedures simultaneously.

I would like to ask if the treatment options I am considering are appropriate based on my symptoms, and whether it would be advisable to pursue both treatments concurrently.
I have heard that surgery on the nasal septum or turbinates carries risks of recurrence and the potential for empty nose syndrome, which is a concerning complication.
Additionally, the ENT physician mentioned that my condition in this regard is not severe enough to warrant surgical intervention.

Mr. S, 40~49 year old female. Ask Date: 2014/11/16

Dr. Zheng Jueyi reply Otolaryngology

Dear Mr.
S,
Regarding the symptoms of snoring, it is advisable to wait for the results of the polysomnography (PSG) and have an evaluation by an otolaryngologist before deciding whether surgery is necessary, and if so, which type of surgery would be most appropriate.
As for allergic rhinitis or vasomotor rhinitis, a visit to the hospital for examination and assessment is still required, and it is recommended to discuss the need for surgery in detail with your physician.
Additionally, stress can lead to various physical and mental symptoms.
It may be beneficial to address these issues first, and consulting a psychiatrist could be a viable option.
Improving stress-related problems may naturally alleviate many symptoms, potentially reducing the need for more invasive surgical interventions.
Wishing you peace and good health.
Sincerely,
Dr.
Jue-Yi Cheng
Director, Department of Otolaryngology
Taoyuan Hospital, Ministry of Health and Welfare

Reply Date: 2014/11/16

More Info

Managing Obstructive Sleep Apnea (OSA) and Non-Allergic Rhinitis can be quite challenging, especially when both conditions coexist and are exacerbated by stress and environmental factors. Your situation, characterized by OSA and non-allergic rhinitis (also known as vasomotor rhinitis), presents a complex interplay of symptoms that can significantly impact your quality of life.

Understanding OSA and Non-Allergic Rhinitis
Obstructive Sleep Apnea (OSA) is a sleep disorder characterized by repeated interruptions in breathing during sleep due to the relaxation of throat muscles. This can lead to fragmented sleep and a host of daytime symptoms, including excessive daytime sleepiness, fatigue, and cognitive impairment. The Apnea-Hypopnea Index (AHI) is a key measure used to assess the severity of OSA, with higher values indicating more severe obstruction.

Non-allergic rhinitis, on the other hand, is a condition that causes nasal congestion, runny nose, and other symptoms without the presence of allergens. It can be triggered by various factors, including changes in temperature, humidity, and irritants like smoke or dust. This condition can contribute to nasal obstruction, which may worsen OSA symptoms by further narrowing the airway during sleep.

Treatment Options
1. Lifestyle Modifications:
- Weight Management: If applicable, losing weight can significantly reduce the severity of OSA.

- Sleep Position: Sleeping on your side rather than your back can help keep the airway open.

- Avoiding Alcohol and Sedatives: These substances can relax the throat muscles and exacerbate OSA.

2. Medical Management:
- Nasal Corticosteroids: These can help reduce inflammation in the nasal passages, alleviating symptoms of non-allergic rhinitis.

- Antihistamines: While primarily used for allergic rhinitis, some may find relief from symptoms with certain antihistamines.

- Decongestants: These can provide temporary relief from nasal congestion but should be used cautiously, especially in individuals with high blood pressure.

3. Continuous Positive Airway Pressure (CPAP):
- This is the first-line treatment for moderate to severe OSA. It involves wearing a mask during sleep that delivers a continuous stream of air to keep the airway open. If you have had difficulty with CPAP, discussing alternative options with your healthcare provider is essential.

4. Surgical Options:
- Uvulopalatopharyngoplasty (UPPP): This surgery removes excess tissue from the throat to widen the airway.

- Genioglossus Advancement: This procedure repositions the tongue muscle attachment to prevent airway collapse.

- Nasal Surgery: If structural issues in the nasal passages contribute to your symptoms, surgical options may be considered, such as turbinate reduction or septoplasty.

5. Psychological Support:
- Given the stress and anxiety you are experiencing, it may be beneficial to consult with a mental health professional. Addressing psychological factors can sometimes lead to improvements in physical symptoms.

Considerations for Combined Treatment
Given your symptoms and the complexity of your conditions, it is crucial to have a comprehensive evaluation by specialists in both sleep medicine and ENT (Ear, Nose, and Throat). While it may be tempting to pursue simultaneous surgical interventions for both OSA and non-allergic rhinitis, it is essential to weigh the risks and benefits carefully.
- Surgical Risks: As you mentioned, surgeries like septoplasty and turbinate reduction carry risks such as recurrence of symptoms and complications like empty nose syndrome. Therefore, a thorough discussion with your ENT specialist about the necessity and timing of these procedures is vital.

- Sequential Approach: In many cases, a sequential approach may be more prudent. For instance, starting with CPAP therapy and medical management for rhinitis before considering surgical options could provide insights into which symptoms improve and whether surgery is necessary.

Conclusion
In summary, managing OSA and non-allergic rhinitis requires a multifaceted approach that includes lifestyle changes, medical management, and possibly surgical interventions. Given the complexity of your symptoms and the interplay between psychological stress and physical health, a coordinated care plan involving specialists in sleep medicine and ENT is essential. Regular follow-ups and open communication with your healthcare providers will help tailor the most effective treatment strategy for your unique situation.

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