Development of a Composite Measure of the Nasal Airway

Sleep Apnea Research Group
Prinipal Investigator: Derek J. Lam, MD
Co-Prinipal Investigator: Edward M. Weaver, MD, MPH
Co-Investigators: Kathryn T. James, PA, MPH; Danna Lei, BS; Aliya Hashemi BS; Benjamin Reed
Sponsor: American Academy of Otolaryngology-Head & Neck Surgery
Objectives:
1. Develop a composite measure of the nasal airway including objective and subjective validated parameters.
2. Validate the composite measure in an independent sample of patients.
Background – Acoustic rhinometry and nasal peak inspiratory flow are validated methods for measuring anatomic and functional aspects of the nasal airway. The Nasal Obstruction Subjective Evaluation (NOSE) scale is a validated measure of the subjective experience of nasal airway obstruction and a visual analog scale is another means of measuring subjective nasal obstruction. Our preliminary data indicate that the objective nasal parameters do not correlate with the subjective measures of nasal obstruction, suggesting they may measure different aspects of the nasal airway. We hypothesize that a composite measure will be a more sensitive and responsive measure of the nasal airway compared to any single measure.
Study Design – Prospective cohort study of 300 consecutive new sleep apnea patients being evaluated with multiple nasal measures at baseline and followed for CPAP use. Instrument will be developed with first 200 patients and validated with next 100 patients.
Methods – The instrument will be developed using 1) multivariable linear regression analysis to develop a multivariable model, and 2) conjunctive consolidation to create a three-stage “nasal obstruction index,” using components of the NOSE scale, nasal obstruction visual analog scale, physician nasal exam, acoustic rhinometry parameters, and nasal flow parameters that are most strongly associated with nasal outcomes. These components will be combined in a single composite score (linear regression model) or a three-stage index (conjunctive consolidation), and each will be tested in an independent sample for hypothesized associations between the nasal airway and other relevant variables.
Conclusion – A composite score will represent a more comprehensive measure of the nasal airway compared to any single measure. We predict such a measure will offer superior prognostication of nasal outcomes and will have broad applications in otolaryngology and related fields.