sleep study

[Amy2]

For years, I have had "reactive airway symptoms" triggered by viruses etc.  Between November and April, I typically have three or four bouts of broncial constriction.  My doctor sent me to a pulmonologist to get a firmer dx and treatment plan.  The pulmonologist did spirometry, checked my nasal passage, chest x tray etc which all make sense.  She ordered a rasp test also.  Apparently, there are no nodules on my vocal chords but I do have redness which is indicitive of reflux.  They also did a test to see if there is air flow constriction in my nasal passage.  There is some constriction.  I had a sleep study done about 16 months ago which indicated that I had borderline sleep apnea.  I have since lost 10 lbs which places me within 10 lbs of my ideal weight.  The pulmonologist wants to repeat the sleep study. They have a small two patient sleep lab on premisis.  Is there any possible correlation between my bronchial issues and apnea?  I don't mind repeating the study again if there is a valid reason but I don't want to have the study just because my insurance will cover it.

[Steven Y Park, MD]

Yes, there can be a link. Every time you stop breathing, you create a vacuum effect that can suck up your stomach juices into your throat (causing your voice box inflammation which can lead to hoarseness, cough, lump sensation and post-nasal drip). It's been shown that stomach contents can then either go into your lungs or into your ears or sinuses. Consider that it's not just acid, but bile, digestive enzymes, and bacteria that's coming up. They've actually found digestive enzymes such as pepsin and H. pylori bacteria in lung and ear/sinus infection fluid. Imagine if you put small amounts of stomach juices into your lungs. It can cause or aggravate bronchitis, cough, asthma or pneumonia.

What you're describing is a vicious cycle. A simple cold, allergy or weather change can cause inflammation in your upper passageways. If your nose is stuffy due to a cold, your tongue can fall back easier during deep sleep, obstructing and sucking up stomach juices, which can cause further inflammation.

Now that you are lighter, are your "bronchial" symptoms better? If so, then all the sleep study will show is that your numbers are lower. If you're not any better, a sleep study will just confirm that you still have sleep apnea. There must be a reason to order a sleep study, and not "just to see." Is your doctor considering CPAP? If so, a CPAP titration study should be ordered (or a split night study, where the first half is a regular study and the second night is to measure the right pressure using a mask, if you have significant apneas). Even if you officially don't have obstructive sleep apnea, you could still have upper airway resistance syndrome, which I describe in more detail in my other posts or on my website at doctorstevenpark.com.

[Amy2]

It was interesting to read about the possible connection of apnea,reflux, post nasal drip and bronchial symptoms. I have had post nasal drip for years and have been experiencing heart burn a few times a week the last five or six months.  I just started taking Nexium today.

I also read on your website about nasal airway constriction and its possible link to bronchial problems.  About 18 years ago, I was sent to an ENT after having repeated problems with sinus infections and bronchitis.  The ENT found that my septum was deviated, leaving only a very small space on one side.  He said that any irritation could cause the nasal passage to completely close, setting me up for infection.  I did have surgery to correct the deviated septum and remove the turbinates.  I had a significant reduction in sinus infections for about 9 or 10 years.  A cold would just stay a cold.  I did have a cat scan of my sinuses about 14 months ago and the results were normal.  The only thing found was a little bit of mucous.  

Could scar tissue have formed as a result of head colds etc causing my bronchial symptoms to again flare up?  Would that show up on a Cat Scan?

I did get a cpap machine about 15 or 16 months ago, which I used for about 7 or 8 weeks. I was able to use the machine 5 or 6 hours a night. The masks (tried three styles) were so hard to sleep with that I kind of gave up.  

At this point, if I were to consider using the machine again, would I need another titration study?

In light of the possible connection between apnea and reflux, post nasal drip etc, it may make sense to try the cpap again if I still have apnea. Two of the doctors at the practice are board certified in pulmonology and critical care medicine and two are board certified in sleep medicine.