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Just as nasal breathing is critically important to any OSA/UARS patient who attempts PAP therapy, care should be taken to monitor nasal health in patients using oral appliance therapy (OAT). Every effort must be made to promote smooth nasal airflow and any
nasal congestion issues must be aggressively treated, particularly nonallergic rhinitis. Different combinations of medication, nasal sprays, and nasal or sinus rinses may be required to take control of both allergic and nonallergic rhinitis.
Beyond treatment of congestion, there is also the nasal dilator approach that assumes nasal breathing can be further improved even when no congestion is present. In two prior posts, I delved into many aspects of nasal dilator strip (NDS) therapy describing
our prior research as well as current
application tips. In these posts I expressed my strong enthusiasm for the use of NDS therapy in patients using PAP therapy. Additionally, the marketplace often serves as its own form of evidence as many people today regularly use NDS therapy because they are happy with their results.
With OAT, NDS therapy is equally important as the dynamics of the dental device assume normal nasal airflow – if not enhanced nasal airflow. Unfortunately, many sleep professionals give nasal strips a bad rap. Some have gone so far as to declare that nasal strips only function as a placebo when used as a sleep breathing aid. Two additional review articles were released recently, one of which only looked at objective data and again declared limited to no value from NDS therapy. The second review looked at the effect of nasal strips on the internal nasal valve and declared the device has some degree of efficacy. This was without commenting on its use in sleep breathing disorders, however, as their selection of research articles excluded patients with sleep apnea or metrics of sleep quality. One final study of immense interest looked at the objective effects of NDS therapy on changes in the internal nasal airspace and documented significant anatomical enlargement, and they proved their point by using a placebo device for comparison.
Putting all this research together we come up with an obvious paradox. On the one hand, there are many who still believe that NDS therapy is a placebo. On the other hand, there are both objective and subjective signs that NDS improves nasal patency and nasal airflow. How do we reconcile this seemingly conflictual information? The answer is quite simple, but it has never been researched. If patients report breathing better and sleeping better as they did in our randomized controlled trial of NDS therapy, the most obvious explanation would be that the improved nasal patency improved sleep breathing sufficiently to make a difference in the quality of sleep. Why then has this crucial point not been conclusively demonstrated in past research studies? Again, the answer is simple: no one has conducted an randomized controlled study to actually measure the subtle change in breathing likely to be consistent with the findings and reports of patients who insist they sleep better with NDS therapy.
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