Clinical Effectiveness of Nasal Dilators in Sleep-Disordered Breathing: A Systematic Review and Meta-Analysis

Background: Nasal dilators are widely used as a noninvasive intervention for snoring and obstructive sleep apnea (OSA), yet their objective effects on sleep-disordered breathing and polysomnographic outcomes remain uncertain. This systematic review and meta-analysis aim to assess the effectiveness of nasal dilators in managing sleep-disordered breathing. Methods: Scopus, PubMed, Web of Science, and ProQuest were systematically searched from inception to January 2024 for studies assessing the efficacy of internal or external nasal dilators in adult patients with sleep-disordered breathing. The standardized mean difference (SMD) was used to pool and compare the findings across studies using a random-effects model. Results: Our search strategy yielded 290 records, of which 17 studies with a pooled population size of 496 participants were found to be eligible for inclusion. We did not find any significant differences in apnea-hypopnea index, apnea index, hypopnea index, snoring index, sleep time, sleep architecture, REM latency, oxygen saturation, and nasal airway resistance between participants who received nasal dilators and control subjects. Conclusions: Nasal dilators cannot be recommended as monotherapy for sleep-disordered breathing. However, it may be helpful as adjunctive therapy in specific populations with mild symptoms or nasal congestion.