Nasal breathing is the preferred mode of respiration.  Many patients are habitual mouth breathers and chronic mouth breathing is associated with nasal airway obstruction.  The nose acts as a carburetor of the body and warms ,filters and humidifies the air.  It aids in the absorption of oxygen by the lungs. That’s why success of Oral Appliance Therapy and compliance with CPAP is greatly improved by opening the nasal airway.

The relationship between the nasal airway and Sleep Disordered Breathing (SDB) is very complex and not understood in every detail.  Nasal obstruction may have a negative impact on sleep quality and is considered a cofactor in the pathophysiology of SDB.  For the majority of patients, normalization of nasal resistance has a positive impact on well being and sleep quality but not necessarily on the severity of OSA.

The nasal valve is the narrowest part of the whole nasal cavity and is the maximum area of nasal airway resistance.  It is formed by the septum, inferior turbinate, and inferior border of the lower lateral cartilage.  Although not a true anatomic structure , it regulates airflow through the nose.  It is affected by allergy, inflammation of the inferior turbinates, and septal deviation.  Treatments aimed at reducing the size of the inferior turbinate vs nasal septal surgery have a greater effect on reducing nasal resistance.

Since the inspiratory pressure required to draw air through the nose is related to the 4^th power of the radius (Poiseuille’s law), a small change or improvement in the opening of the nasal valve translates into a large decrease in the pressure required to inspire air.  When there is an increase in nasal airway resistance (or obstruction) there is a dramatic increase in the inspiratory pressure which leads to airway collapse and increased risk for OSA.

The importance of the nasal valve in nasal obstruction has been known for years but correction of nasal valve issues required open surgical procedures with limited success.  The VivAer (www.aerinmedical.com)  airway  remodeling procedure has revolutionized our ability to address nasal obstruction with a simple and predictable office -based solution.