Is nasal obstruction the overlooked culprit behind CPAP intolerance? On this episode of BackTable ENT & Allergy, Dr. Gopi Shah interviews Dr. Atul Malhotra and Dr. Michael Hutz to examine the critical but often underappreciated role of the nose in obstructive sleep apnea management. They discuss how nasal obstruction can undermine CPAP adherence, why relying solely on AHI may miss key issues, and how identifying the true cause of intolerance can lead to more personalized and effective therapy.
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This podcast is supported by
Aerin Medicalhttps://vivaer.com/
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Timestamps
00:00 - Introduction04:05 - OSA Presentation and AHI Limitations08:13 - Understanding CPAP Intolerance and Nasal Obstruction15:24 - Evaluating Nasal Obstruction20:32 - Nasal Anatomy and Workup27:47 - DICE Technique and Assessing Dynamic Nasal Collapse32:51 - Medical and Non-Surgical Management37:29 - Surgical Options and VivAer43:39 - Nasal Procedures and CPAP Success51:57 - Nasal Surgery and Heart Outcomes55:23 - Beyond CPAP: Nasal Breathing, Myofunctional Therapy, and Collaborative Care01:04:51 - Wrap Up
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More about this episode
The physicians review practical strategies for evaluating nasal obstruction, from targeted patient questionnaires, physical exams, nasal endoscopy, and selective imaging. The doctors also detail medical and surgical treatment options, from allergy management and nasal sprays to septoplasty, turbinate reduction, functional rhinoplasty, and temperature-controlled radiofrequency (VivAer). Throughout the episode, they highlight how comprehensive nasal evaluation and intervention can significantly improve CPAP comfort and adherence.
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Resources
Dr. Atul Malhotra - https://providers.ucsd.edu/details/22362/sleep-medicine-pulmonology-(lung)
Dr. Michael Hutz- https://doctors.rush.edu/details/19100
CPAP treatment persistence following nasal procedures in obstructive sleep apnea - https://www.tandfonline.com/doi/pdf/10.1080/13696998.2026.2671550
Design and rationale for treating Obstructive Sleep Apnea using Targeted Hypoglossal Nerve Stimulation trial - https://www.sciencedirect.com/science/article/pii/S1551714422001306
The Impact of Mouth-Taping in Mouth-Breathers with Mild Obstructive Sleep Apnea - https://pmc.ncbi.nlm.nih.gov/articles/PMC9498537/
VATRAC Trial of VivAer - https://aerinmedical.com/company/news-and-media/aerin-medical-announces-positive-two-year-outcomes-from-the-vatrac-trial-of-vivaer/
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