0614 Impact of Physiological and Subjective Metrics on Nasal Obstruction in Patients on Positive Airway Pressure Therapy: A Multi-Variable Analysis

Abstract Introduction Nasal obstruction may impede Positive Airway Pressure (PAP) therapy adherence in patients with Obstructive Sleep Apnea. The Nasal Obstruction Symptom Evaluation (NOSE) questionnaire may help quantify nasal obstruction, and identifying pre-treatment characteristics that predict high NOSE scores may help improve adherence to PAP therapy. This study aimed to determine which physiological or symptomatic variables independently predict baseline NOSE scores. Methods We conducted a retrospective chart review of 110 adult patients initiated on PAP therapy at the James A. Haley Veterans’ Hospital. We employed a Multiple Linear Regression (MLR) analysis, using the NOSE score as the dependent variable and Age, Body Mass Index (BMI), baseline Apnea Hypopnea Index (AHI), SpO2 Nadir, Epworth Sleepiness Scale (ESS), and Insomnia Severity Index (ISI) as independent predictors. Simple Linear Regression (SLR) analyses were also performed for each predictor individually to assess univariate correlations. Results The average NOSE score for the cohort was 43.2. The overall MLR model was highly statistically significant (p = 5.85 x 10-7), explaining a moderate portion of the variance in NOSE scores (Adjusted R2 = 0.273). Of the six variables entered into the MLR model, only the ISI was identified as a statistically significant independent predictor of NOSE score (p = 9.9 x 10-6). The other predictors did not meet the significance threshold in the multi-variable model. However, individual SLR analyses confirmed significant univariate correlations between NOSE score and Age (p = 0.031, R2 = 0.0331), ESS (p = 0.000302, R2 = 0.106), and ISI (p = 9.15 x 10-9, R2 = 0.2575). Conclusion Based on the MLR and SLR analyses, ISI is the strongest independent predictor of baseline nasal obstruction (NOSE score). Although other factors show univariate correlations, ISI is the only factor that retains significance when controlling for the confounding effects of the other variables. This suggests a correlation between subjective poor sleep quality and self-reported nasal symptoms. Given that nasal obstruction can reduce PAP adherence, patients presenting with insomnia should be specifically evaluated for nasal obstruction. Screening these patients using the NOSE questionnaire offers a targeted strategy to identify those who could benefit from treatment, which may improve PAP adherence. Support (if any)