Can Sleep Apnea Cause Chronic Sinusitis?

May 25, 2011

Here’s my response below to a NY Times article on chronic sinusitis. They talk about cutting edge research in diagnosing and treating sinusitis, but completely miss an important point. Please read my post below to see what I mean, and feel free to comment on anything that I’ve said.

Biofilms are the pathology de jour in chronic sinusitis research right now. A few years ago, it was our immune system’s response to funguses. Before that, it was allergies, and before that, bacteria. As long as we’re convinced that it’s a bad organism or agent that’s attacking our body (sinus) cavities, you may get rid of the infection, but you’re doing nothing to treat what’s actually causing the inflammation that leads to blockage of the sinuses. The same analogy can be made for anti-reflux medications. None of the proton pump inhibitors (like Prilosec or Nexium) or H2 blockers (like Zantac) actually do anything to prevent reflux. It only lowers acid production, without doing anything to prevent regurgitation of stomach juices into the esophagus or throat.

Interestingly, a recent large scale study showed that the vast majority of people who suffer from recurrent sinus infections, pain and headaches are actually suffering from migraines. This is a neurologic form of inflammation in the sinuses, which over-reacts to weather changes, chemicals, scents, or odors. Chronic inflammation can lead to swelling, leading to blockage of sinuses, which can predispose to infections by bacteria that normally live in your nose.

Saline is also commonly recommended for chronic sinus sufferers, but it’s a double edged sword: A recent study showed that people who used nasal saline irrigation frequently had more episodes of infection than those who didn’t. Yes, saline irrigation flushes out pollutants and bacteria, but it can also cause paralysis of the cilia, which are finger-like projections that move nasal mucous back into your throat. Saline is like a mild version of Afrin – it’s still a decongestant. This is why some people have to use saline every day, sometimes 3-5 times per day. They’re addicted, just like with Afrin.

Sinus problems are much more common these days due to underdevelopment of our facial bones, which also include our jaws. Over the past few hundred years, due to a radical shift in our diets, as well as our eating habits (soft, mushy foods, bottle feeding, etc.), our jaws are not expanding to their full potential. If your facial skeletons don’t grow as much, the natural nasal and sinus passageways will be more narrow, becoming more predisposed to obstruction with colds, allergies, or any kind of inflammation.

This is why most people with chronic sinusitis can’t (or prefer not to) sleep on their backs. Due to smaller oral cavity volume, the tongue takes up relatively too much space, which leads to more frequent obstruction while breathing at night. Breathing pauses (apneas) then can suction up your normal stomach juices into your throat, lungs and nose, causing more inflammation. Most people with chronic sinusitis will also have sleep-difficulty and one or both parents will be heavy snorers with typically undiagnosed sleep apnea.

I presented a poster many years ago looking at the incidence of obstructive sleep apnea in people who had persistent or recurrent symptoms after nasal or sinus surgery. Almost 80% were found to have significant obstructive sleep apnea. Now that I look for and treat sleep-breathing problems before considering surgery, the need to go on to sinus surgery has plummeted. Plus they sleep better.

 

Nasal Polyps And Erectile Dysfunction: How It May Link To Sleep Apnea

April 21, 2011

I just came across this article showing that treating nasal polyps with sinus surgery can help men with erectile disfunction (ED). My initial reaction was that any type of nasal surgery can help with sleep-breathing problems, whether or not it’s obstructive sleep apnea.

The authors studied 35 patients who were confirmed to have nasal polyps. They excluded anyone with any known risk factors for ED, such as obstructive sleep apnea, diabetes, hypertension, obesity, or any neurologic conditions. All the subjects underwent a validated questionnaire for ED, as well as nocturnal penile tumescence (NPT) testing. Before surgery, 34.5% of these patients had ED based on the validated questionnaires, compared to 3.3% in controls. After surgery, the percent of people with ED dropped to 10.3%. NPT testing improved significantly as well.

Despite the fact the they excluded everyone with obstructive sleep apnea, it’s likely that having nasal congestion potentially aggravated sleep-breathing problems, leading to increased adrenaline levels. Having a stuffy nose causes a vacuum effect downstream in the throat, which allows the tongue to fall back more easily, causing obstructions and arousals. These breathing pauses may not be called apneas, but they can cause deep sleep disruption, leading to inefficient sleep and increased states of physiologic stress. Any type of stress, whether it’s physiologic, emotional, or psychological stress, can aggravate ED by the following mechanism:

Arousal and erection in men is mediated by the parasympathetic nervous system (the relaxation response). Orgasm is activated by the sympathetic nervous system (fight-or-flight response). If there’s too much sympathetic activation, you’re not going to have enough relaxation of the smooth muscle that allows blood to fill up the penis. Relaxing this muscle can be accomplished using medications, relaxation techniques, herbs or supplements.

Add one more option to this list: Better sleep by better breathing.

The material on this website is for educational and informational purposes only and is not and should not be relied upon or construed as medical, surgical, psychological, or nutritional advice. Please consult your doctor before making any changes to your medical regimen, exercise or diet program.



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