Effect of nostril occlusion and mouth sealing in the measurement of sniff nasal inspiratory pressure

Neeraj M. Shah; Anne Rossel; Bawan Abdulaziz; Shauna Sheridan; Sophie Madden-Scott; Gillian Radcliffe; Rebecca D'Cruz; Eui Sik Suh; Joerg Steier; Nicholas Hart; Patrick Brian Murphy; Michelle Ramsay; Georgios Kaltsakas

doi:10.1136/thorax-2024-221910

Effect of nostril occlusion and mouth sealing in the measurement of sniff nasal inspiratory pressure

Neeraj M. Shah^*, Anne Rossel, Bawan Abdulaziz, Shauna Sheridan, Sophie Madden-Scott, Gillian Radcliffe, Rebecca D'Cruz, Eui Sik Suh, Joerg Steier, Nicholas Hart, Patrick Brian Murphy, Michelle Ramsay, Georgios Kaltsakas

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Sniff nasal inspiratory pressure (SNIP) is used to assess respiratory muscle strength in neuromuscular diseases like amyotrophic lateral sclerosis (ALS). The effect of contralateral nostril occlusion and mouth sealing on SNIP measurement are unclear. 81 participants were included (16 healthy, 39 patients with limb-onset ALS and 26 patients with bulbar-onset ALS). SNIP was obtained with combinations of mouth open/sealed and contralateral nostril open/occluded. Occluding the contralateral nostril (with mouth closed) increased SNIP by 12 cmH2O (95% CI 4, 20; p=0.003) in the healthy participants, by 9 cmH2O (95% CI 5, 12; p<0.001) in the limb-onset cohort and by 10 cmH2O (95% CI 5, 14; p<0.001) in the bulbar-onset cohort. Opening the mouth decreased SNIP by 19 cmH2O (95% CI 5, 34; p<0.009) in healthy participants, by 8 cmH2O (95% CI 4, 13; p<0.001) in the limb-onset cohort and by 13 cmH2O (95% CI 7, 19; p<0.001) in the bulbar-onset cohort. With contralateral nostril occlusion, 11% fewer individuals would have qualified for non-invasive ventilation. In conclusion, contralateral nostril occlusion increased SNIP compared with standard technique, likely reflecting true strength. Opening the mouth reduced SNIP, emphasising the need for good mouth sealing. Documenting SNIP technique is important for longitudinal assessments and clinical decision-making.

Original language	English
Journal	Thorax
DOIs	https://doi.org/10.1136/thorax-2024-221910
Publication status	Accepted/In press - 2024

Keywords

respiratory measurement
respiratory muscles

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10.1136/thorax-2024-221910

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@article{81ecf22bf2694fa4af7ad036dd9f28e8,

title = "Effect of nostril occlusion and mouth sealing in the measurement of sniff nasal inspiratory pressure",

abstract = "Sniff nasal inspiratory pressure (SNIP) is used to assess respiratory muscle strength in neuromuscular diseases like amyotrophic lateral sclerosis (ALS). The effect of contralateral nostril occlusion and mouth sealing on SNIP measurement are unclear. 81 participants were included (16 healthy, 39 patients with limb-onset ALS and 26 patients with bulbar-onset ALS). SNIP was obtained with combinations of mouth open/sealed and contralateral nostril open/occluded. Occluding the contralateral nostril (with mouth closed) increased SNIP by 12 cmH2O (95% CI 4, 20; p=0.003) in the healthy participants, by 9 cmH2O (95% CI 5, 12; p<0.001) in the limb-onset cohort and by 10 cmH2O (95% CI 5, 14; p<0.001) in the bulbar-onset cohort. Opening the mouth decreased SNIP by 19 cmH2O (95% CI 5, 34; p<0.009) in healthy participants, by 8 cmH2O (95% CI 4, 13; p<0.001) in the limb-onset cohort and by 13 cmH2O (95% CI 7, 19; p<0.001) in the bulbar-onset cohort. With contralateral nostril occlusion, 11% fewer individuals would have qualified for non-invasive ventilation. In conclusion, contralateral nostril occlusion increased SNIP compared with standard technique, likely reflecting true strength. Opening the mouth reduced SNIP, emphasising the need for good mouth sealing. Documenting SNIP technique is important for longitudinal assessments and clinical decision-making.",

keywords = "respiratory measurement, respiratory muscles",

author = "Shah, {Neeraj M.} and Anne Rossel and Bawan Abdulaziz and Shauna Sheridan and Sophie Madden-Scott and Gillian Radcliffe and Rebecca D'Cruz and Suh, {Eui Sik} and Joerg Steier and Nicholas Hart and Murphy, {Patrick Brian} and Michelle Ramsay and Georgios Kaltsakas",

note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2024.",

year = "2024",

doi = "10.1136/thorax-2024-221910",

language = "English",

journal = "Thorax",

issn = "0040-6376",

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TY - JOUR

T1 - Effect of nostril occlusion and mouth sealing in the measurement of sniff nasal inspiratory pressure

AU - Shah, Neeraj M.

AU - Rossel, Anne

AU - Abdulaziz, Bawan

AU - Sheridan, Shauna

AU - Madden-Scott, Sophie

AU - Radcliffe, Gillian

AU - D'Cruz, Rebecca

AU - Suh, Eui Sik

AU - Steier, Joerg

AU - Hart, Nicholas

AU - Murphy, Patrick Brian

AU - Ramsay, Michelle

AU - Kaltsakas, Georgios

PY - 2024

Y1 - 2024

N2 - Sniff nasal inspiratory pressure (SNIP) is used to assess respiratory muscle strength in neuromuscular diseases like amyotrophic lateral sclerosis (ALS). The effect of contralateral nostril occlusion and mouth sealing on SNIP measurement are unclear. 81 participants were included (16 healthy, 39 patients with limb-onset ALS and 26 patients with bulbar-onset ALS). SNIP was obtained with combinations of mouth open/sealed and contralateral nostril open/occluded. Occluding the contralateral nostril (with mouth closed) increased SNIP by 12 cmH2O (95% CI 4, 20; p=0.003) in the healthy participants, by 9 cmH2O (95% CI 5, 12; p<0.001) in the limb-onset cohort and by 10 cmH2O (95% CI 5, 14; p<0.001) in the bulbar-onset cohort. Opening the mouth decreased SNIP by 19 cmH2O (95% CI 5, 34; p<0.009) in healthy participants, by 8 cmH2O (95% CI 4, 13; p<0.001) in the limb-onset cohort and by 13 cmH2O (95% CI 7, 19; p<0.001) in the bulbar-onset cohort. With contralateral nostril occlusion, 11% fewer individuals would have qualified for non-invasive ventilation. In conclusion, contralateral nostril occlusion increased SNIP compared with standard technique, likely reflecting true strength. Opening the mouth reduced SNIP, emphasising the need for good mouth sealing. Documenting SNIP technique is important for longitudinal assessments and clinical decision-making.

AB - Sniff nasal inspiratory pressure (SNIP) is used to assess respiratory muscle strength in neuromuscular diseases like amyotrophic lateral sclerosis (ALS). The effect of contralateral nostril occlusion and mouth sealing on SNIP measurement are unclear. 81 participants were included (16 healthy, 39 patients with limb-onset ALS and 26 patients with bulbar-onset ALS). SNIP was obtained with combinations of mouth open/sealed and contralateral nostril open/occluded. Occluding the contralateral nostril (with mouth closed) increased SNIP by 12 cmH2O (95% CI 4, 20; p=0.003) in the healthy participants, by 9 cmH2O (95% CI 5, 12; p<0.001) in the limb-onset cohort and by 10 cmH2O (95% CI 5, 14; p<0.001) in the bulbar-onset cohort. Opening the mouth decreased SNIP by 19 cmH2O (95% CI 5, 34; p<0.009) in healthy participants, by 8 cmH2O (95% CI 4, 13; p<0.001) in the limb-onset cohort and by 13 cmH2O (95% CI 7, 19; p<0.001) in the bulbar-onset cohort. With contralateral nostril occlusion, 11% fewer individuals would have qualified for non-invasive ventilation. In conclusion, contralateral nostril occlusion increased SNIP compared with standard technique, likely reflecting true strength. Opening the mouth reduced SNIP, emphasising the need for good mouth sealing. Documenting SNIP technique is important for longitudinal assessments and clinical decision-making.

KW - respiratory measurement

KW - respiratory muscles

UR - http://www.scopus.com/inward/record.url?scp=85207736055&partnerID=8YFLogxK

U2 - 10.1136/thorax-2024-221910

DO - 10.1136/thorax-2024-221910

M3 - Article

C2 - 39375041

AN - SCOPUS:85207736055

SN - 0040-6376

JO - Thorax

JF - Thorax

ER -

Effect of nostril occlusion and mouth sealing in the measurement of sniff nasal inspiratory pressure

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