Fractional exhaled nitric oxide-a possible biomarker for risk of obstructive sleep apnea in snorers

Eva Kiaer*, Andreas Ravn, Poul Jennum, Christian Prætorius, Roland Welinder, Steffen Ørntoft, Christian von Buchwald, Vibeke Backer

*Corresponding author for this work


STUDY OBJECTIVES: Airway inflammation in patients with obstructive sleep apnea (OSA) has been described and can be assessed by measuring the biomarker fractional exhaled nitric oxide (FeNO). In this pilot study, we investigated FeNO measurements in identification of OSA among persons with snoring.

METHODS: In this study we aimed to investigate (1) if FeNO could be used in screening for OSA, (2) if daytime sleepiness correlated to FeNO levels, and (3) whether asthma affected FeNO levels. Persons with snoring were prospectively included in three primary care ear, nose, and throat clinics. Patients underwent spirometry, FeNO tests, and partial polygraphy. They filled out questionnaires on sinonasal and asthma symptoms, daytime sleepiness, and quality of life. Current smokers, patients with upper airway inflammatory conditions, and patients treated with steroids were excluded.

RESULTS: Forty-nine individuals were included. Median apnea-hypopnea index was 11.4, mean age was 50.9 years, and 29% were females. OSA was diagnosed in 73% of the patients of whom 53% had moderate-severe disease. Patients with moderate-severe OSA had significantly higher FeNO counts than patients with no or mild OSA (P = .024). Patients younger than 50 years with a FeNO below 15 had the lowest prevalence of moderate-severe OSA. No correlation was found between FeNO measurements and daytime sleepiness, and asthma did not affect FeNO levels.

CONCLUSIONS: We found a low prevalence of moderate-severe OSA in persons with snoring when FeNO and age were low. This might be considered in a future screening model, though further studies testing the FeNO cutoff level and the diagnostic accuracy are warranted.

CLINICAL TRIAL REGISTRATION: Registry:; Name: NO Measurements in Screening for Asthma and OSA, in Patients With Severe Snoring; URL:; Identifier: NCT03964324.

CITATION: Kiaer E, Ravn A, Jennum P, et al. Fractional exhaled nitric oxide-a possible biomarker for risk of obstructive sleep apnea in snorers. J Clin Sleep Med. 2024;20(1):85-92.

Original languageEnglish
JournalJournal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
Issue number1
Pages (from-to)85-92
Number of pages8
Publication statusPublished - 1 Jan 2024


  • Asthma/complications
  • Biomarkers
  • Disorders of Excessive Somnolence/diagnosis
  • Female
  • Fractional Exhaled Nitric Oxide Testing
  • Humans
  • Male
  • Middle Aged
  • Pilot Projects
  • Quality of Life
  • Sleep Apnea, Obstructive/complications
  • Snoring/complications


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