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Open Access 01-09-2019 | Sleep Breathing Physiology and Disorders • Original Article

Measurement of fractional exhaled nitric oxide and nasal nitric oxide in male patients with obstructive sleep apnea

Authors: Dongmei Zhang, Yi Xiao, Jinmei Luo, Xiaona Wang, Yixian Qiao, Rong Huang, Wei Wu

Published in: Sleep and Breathing | Issue 3/2019

Abstract

Objective

Airway inflammation plays an important role in obstructive sleep apnea (OSA); exhaled nitric oxide is regarded as a noninvasive marker of airway inflammation. The aim of this study was to evaluate fractional exhaled nitric oxide (FeNO) and nasal nitric oxide (nNO) in patients with OSA.

Methods

Seventy-five patients with OSA and 30 health controls were enrolled in this study. FeNO and nNO were measured before and after sleep. Nasal lavage was performed in 31 non-smoking individuals immediately after NO measurement in the morning. The sample of nasal lavage was taken for cell classification and analyzing interleukin 6 (IL-6) and interleukin 8 (IL-8).

Results

Both FeNO and nNO were significantly higher in OSA (before sleep FeNO 21.08 ± 8.79 ppb vs.16.90 ± 6.86 ppb, p = 0.022; after sleep FeNO 25.57 ± 15.58 ppb vs.18.07 ± 6.25 ppb, p = 0.003; before sleep nNO 487.03 ± 115.83 ppb vs. 413.37 ± 73.10 ppb, p = 0.001; after sleep nNO 550.07 ± 130.24 ppb vs. 460.43 ± 109.77 ppb, p < 0.001). Furthermore, in non-smoking OSA, nNO levels were positively correlated with apnea hypopnea index (AHI) and average decrease of pulse arterial oxygen saturation (SpO₂); after sleep, nNO was also positively associated to recording time with SpO₂ < 90% and negatively associated to minimum SpO₂. Both before and after sleep nNO levels were positively correlated with the percentage of neutrophils in nasal lavage (r = 0.528, p = 0.014; r = 0.702, p < 0.001, respectively). Additionally, before sleep nNO was also positively associated with IL-6 (r = 0.586, p = 0.005) and IL-8 (r = 0.520, p = 0.016) concentration.

Conclusion

This study sustains the presence of airway inflammation in OSA patients with the increase of FeNO and nNO. The data suggests nNO might have greater value than FeNO since it positively correlated with OSA severity, and nNO is a potential bio-marker of nasal inflammation in non-smoking OSA patients.

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Title: Measurement of fractional exhaled nitric oxide and nasal nitric oxide in male patients with obstructive sleep apnea
Authors: Dongmei Zhang
Yi Xiao
Jinmei Luo
Xiaona Wang
Yixian Qiao
Rong Huang
Wei Wu
Publication date: 01-09-2019
Publisher: Springer International Publishing
Published in: Sleep and Breathing / Issue 3/2019
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-018-1760-1

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