The prevalence of sleep dysfunction is high in patients with chronic rhinosinusitis (CRS) and significantly improves after endoscopic sinus surgery; in patients with CRS and comordid obstructive sleep apnea (OSA), sinus surgery confers substantial improvements in quality-of-life, according to a new report (JAMA Otolaryngol Head Neck Surg. 2015;141:873-881).
“We found that patients with chronic sinusitis describe fatigue and poor sleep quality even if they don’t have a diagnosis of obstructive sleep apnea,” said Timothy L. Smith, MD, director of the Oregon Sinus Center and chief of rhinology and sinus-skull base surgery at Oregon Health and Science University in Portland, and senior author of the study, which looked at the impact of comorbid OSA on CRS disease-specific quality-of-life outcomes and sleep dysfunction following functional endoscopic sinus surgery.
Of the 405 patients with CRS included in the study, 60 (15%) had comorbid OSA. Based on 285 (70%) of patients who provided survey responses, the study found significant improvement after surgery across all disease-specific quality-of-life measures and Pittsburgh Sleep Quality Index for patients with CRS, regardless of the presence of OSA.
Patients with CRS who did not have comorbid OSA, however, had even greater improvement after surgery in quality-of-life measures including sleep quality and sleep disturbance when compared with those who had comorbid OSA.
The underlying etiology and pathophysiologic mechanism of sleep dysfunction in patients with CRS remains unknown. According to Dr. Smith, the study findings suggest that the decrease in sleep quality in patients with CRS is not simply related to the symptom of nasal obstruction, but “appears to have deep roots within the chronic inflammatory cascade.”
The study found that the status of polyps between CRS patients with or without OSA did not appear to contribute to the difference in sleep dysfunction improvement. The researchers also postulated that better improvement in quality-of-life and sleep in patients with CRS following surgery may be due to improved control of chronic inflammation versus improved nasal obstruction.
“Otolaryngologists should be aware of fatigue and reduced sleep quality related to both chronic rhinosinusitis and obstructive sleep apnea and understand that there appears to be a complex relationship between the two disorders,” said Dr. Smith.