Quote:
> Hello. This posting is for a friend.
> What is the cause for the following? My frined says that he has problems
> breathing through his nose. It feels constantly congested. This is
> specially annoying when he sleeps because if he sleeps on his left side,
> then that nostril gets congested and the right side clears. The opposite
> happens when he turns to his right side. Sleeping on his back does not relieve
> the problem on either side. Can a deviated septum cause this problem?
> Thanks in advance.
> -F.
This is a perfectly normal phenomenon that has been extensively investigated
(including by our cardiology group). Lateral recumbency, especially localized
pressure on the lateral thoracic wall, is accompanied by ipsilateral nasal
congestion and contralateral decongestion (Takagi K, Kobayashi S. Skin
pressure-vegetative reflex. Acta Medica Biologica 1955;4:3-57; Rao S, Potdar A.
Nasal airflow with body in various positions. Journal of Applied Physiology
1970;28:162-165; Cole P, Haight JSJ. Posture and the nasal cycle. Annals of
Otology Rhinology and Laryngology. 1986;95:233-237). Asymmetrical pressure to
the thorax, pelvic and pect{*filter*}girdles elicits this response. Davies and
Eccles (Davies AM, Eccles R. Reciprocal changes in nasal resistance to airflow
caused by pressure applied to the axilla. Acta Otolaryngologica
1985;99:154-159) described the reciprocal nature of the nasal response to
axilla (underarm) pressure. Pressure on the hemithorax from any surface that is
lateral, anterior, posterior, or superior leads to reduced patency of the
ipsilateral side (Singh V. Thoracic pressure and nasal patency. J Applied
Physiology 1987;62:91-94).
The phenomenon of different physiological effects in right vs. left lateral
decubitus position during surgery is well known (Stein P. Tendency towards
hypotension in left lateral recumbency. Archives of Internal Medicine
1952;10:234-242; Eggers GWN et al. Hemodynamic changes associated with various
surgical positions. Journal of the American Medical Association 1963;185:1-5;
Zack MB et al. The effect of lateral positions on gas exchange in pulmonary
disease. American Review of Respiratory Disease 1974;110:49-55; Mills RM. et
al. Coronary sinus {*filter*} flow in trepopneic angina: Case report. Annals of
Internal Medicine 1976;84;295-296; Norton LC, Conforti CG. THe effect of body
position on oxygenation. Heart and Lung 1984;14:45-51; Lange RA et al. Effects
of supine and lateral positions on cardiac output and intracardiac pressures.
American Journal of Cardiology 1988;62:330-333).
The classic paper on the autonomic effects of lateral decubitus position was
done by Takagi (Takagi K. Uber den Einflus des mechanischen Hautdruckes auf die
vegetativen Funktionen. Acta Neurovegetativa 1957;16:439-447. We replicated
this work using autoregressive power spectral analysis of heart rate
variability as an indicator of autonomic tone and found that pressure on the
left side increases sympathetic nervous system activity while pressure on the
right side increases parasympathetic (vagal) activity.
Our group has cautioned asthmatics NOT to sleep on their right side (British
Journal of Clinical Practice 1990;44:448-449). We have explained differential
rates of gastric emptying by this phenomenon (British Journal of Clinical
Pharmacology 1991;32:138-139); explained that pre-breakfast hyperglycemia, the
"dawn" phenomenon may be an artifact due to this (Diabetes Research
1990;14:97-99); suggested that conduction defects (in the heart electrical
system) induced by lateral posture may be caused by the reflex (International
Journal of Cardiology 1992;34:354); have suggested that {*filter*} donors could
take advantage of the right lateral decubitus position to prevent anxiety,
adverse autonomic reaction and syncope (Vox Sanguinis 1991;60:242-243); and
cautioned reseachers in psychological experiments to account for the skin
pressure-vegetative reflex (Brain and Cognition 1990;12:155-157).
Our group also found evidence of the effect of nasal septal deviation on
autonomic tone. Dr. Nelson Matamoros reported a very high incidence of
increased intraocular pressure with nasal septum deviated to the right (Backon
J. et al. British Journal of Ophthalmology 1990;74:607-609). We are currently
investigating incidence of nasal septal deviation in patients with acute
myocardial infarct admitted to our hospital's cardiac intensive care unit.
Josh
Nasal Problems