Study Finds Nocturnal Nasal Congestion in Patients With OSA Is Associated With Uncontrolled BP

A recent study found that nocturnal nasal congestion in patients with hypertension and comorbid obstructive sleep apnea (OSA) was associated with uncontrolled blood pressure (BP).

A cross-sectional, single-center study published in European Archives of Oto-Rhino-Laryngology found that nasal congestion during sleep was associated with high or uncontrolled blood pressure (BP) and more severe obstructive sleep apnea (OSA) measures among patients with hypertension and comorbid OSA. The results suggest that addressing nasal diseases could have a positive effect on achieving hypertension control.

The study was conducted by a sleep medicine center of a tertiary care center. Patients who were aged 18 to 70 years, underwent overnight sleep monitoring, and received a new diagnosis of OSA between March 2018 and December 2021 were selected for this study. Demographic characteristics, BP control, and sleep data were collected from all participants.

Sleepiness and nasal obstruction were measured using the Epworth Sleepiness Scale (ESS) and the Nasal Obstruction Symptom Evaluation (NOSE). Patients were excluded if they had other secondary hypertension, severe systemic disease, other non-OSA sleep disease, or were currently receiving oxygen therapy or OSA treatment.

Uncontrolled hypertension was defined as BP not being controlled at the target (systolic BP <140 mm Hg and diastolic BP <90 mm Hg) despite use of 1 or 2 antihypertensive drugs. Resistant hypertension was defined as failure to achieve BP despite the use of 3 or more antihypertensive medications with lifestyle improvement or 4 or more antihypertensive drugs to control BP.

Patients who self-reported nasal congestion when lying down at night were considered to have nocturnal nasal congestion. The NOSE scale was used to assess state of nasal congestion through a questionnaire, with a score of 100 indicating the most serious symptoms. All participants also underwent an 8-hour sleep test.

There were 326 participants who met the inclusion criteria, with 266 male participants and a mean (SD) age of 49.2 (10.3) years. There were 66 patients with controlled hypertension, 209 with uncontrolled hypertension, and 51 with resistant hypertension; 140 patients had nasal congestion.

Patients with nocturnal nasal congestion had a higher median (IQR) ESS score compared with those without (11 [8-15] vs 13 [9-17]). The patients with nasal congestion also took more antihypertensive drugs (P = .009).

Patients with nocturnal congestion also had more difficult to control BP; the congestion group had a higher proportion of resistant hypertension (11.8% vs 20.7%) and a lower proportion of controlled hypertension (26.3% vs 12.1%).

Compared with patients without nasal congestion, median (IQR) apnea-hypopnea index (23.4 [14.1-43.5] vs 31.7 [19.3-50.7]) and obstructive apnea index (3.4 [0.6-15.8] vs 9.0 [1.7-28.5]) were higher in the nasal congestion group, whereas cumulative sleep time percentage with oxyhemoglobin saturation less than 90% (CT90) was lower (2.0 [0.3-9.4] vs 6.0 [1.0-21.8]).

There were 3 logistic regression models constructed for this study. Model 1 was unadjusted; odds ratio (OR) (95% CI) values associated with nocturnal nasal congestion were 2.36 (1.27-4.36) for uncontrolled hypertension and 3.80 (1.74-8.31) for resistant hypertension. Model 2 was adjusted for age, sex, body mass index, smoking, and alcohol use and identified an independent relationship between nasal congestion and uncontrolled hypertension (OR, 2.26; 95% CI, 1.21-4.21) or resistant hypertension (OR, 3.55; 95% CI, 1.54, 8.18). Model 3 adjusted for OSA severity and CT90 for the relationship between nasal congestion and uncontrolled hypertension (OR, 2.09; 95% CI, 1.11-3.93) or resistant hypertension (OR, 2.96; 95% CI, 1.24-7.03).

There were some limitations to this study. Because BP monitoring and medication use were obtained from office BP readings and patient self-report, the researchers may have overlooked some patients with masked uncontrolled hypertension. The results of this study need to be confirmed by a large prospective cohort study, rather than the cross-sectional data used in this study.

The researchers concluded that their study demonstrated a relationship between nocturnal nasal congestion and uncontrolled BP in patients with hypertension and OSA.

“Effective treatment of severe nasal disease may help control blood pressure in patients, especially those with resistant hypertension,” the researchers wrote.


Guo Y, Wu H, Wei Y. Nocturnal nasal congestion is associated with uncontrolled blood pressure in patients with hypertension comorbid obstructive sleep apnea. Eur Arch Otorhinolaryngol. Published online April 1, 2022. doi:10.1007/s00405-022-07352-4

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