Sinus and apnoea symptoms improved by surgery

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Patients with chronic rhinosinusitis (sinus infection) and obstructive sleep apnoea report a poor quality of life, which is substantially improved following endoscopic sinus surgery, according to a study.

A growing body of literature has highlighted the important links between quality of life (QOL), sleep, and chronic rhinosinusitis (CRS), such that disease severity has been correlated with worse QOL and patients with worse QOL have poor sleep. It is possible that CRS propagates sleep dysfunction through many cofactors including nightly wakening, nasal obstruction, depression and pain, according to background information in the article.

Dr Timothy L Smith, of Oregon Health & Science University, Portland, and colleagues investigated the impact of comorbid obstructive sleep apnoea (OSA) on CRS disease-specific QOL and sleep dysfunction in patients with CRS following functional endoscopic sinus surgery (FESS). The study included 405 patients with a diagnosis of CRS who underwent FESS. Of these participants, 60 (15%) had comorbid OSA. A total of 285 (70%) participants provided preoperative and postoperative survey responses for various measures, with an average of 13.7 months of follow-up.

There was no difference found between those with and without OSA in regards to disease severity or CRS disease-specific QOL, poor sleep, or average sleep quality scores prior to surgery. Following FESS, substantial gains in QOL and disease severity were observed for patients with CRS with and without OSA, and these gains were statistically significant. Participants without OSA reported greater improvements on sleep quality.

“Patients with OSA should be treated concurrently for both CRS and OSA to optimize sleep dysfunction and QOL improvement. Future investigations are needed to further elucidate the discordance and underlying mechanisms of sleep improvement between those patients with and without OSA with objective sleep measures,” the authors write.

Abstract
Importance: Patients with chronic rhinosinusitis (CRS) have reduced sleep quality linked to their overall well-being and disease-specific quality of life (QOL). Other primary sleep disorders also affect QOL.
Objective: To determine the impact of comorbid obstructive sleep apnea (OSA) on CRS disease-specific QOL and sleep dysfunction in patients with CRS following functional endoscopic sinus surgery.
Design, Setting, and Participants: Prospective multisite cohort study conducted between October 2011 and November 2014 at academic, tertiary referral centers with a population-based sample of 405 adults.
Intervention: Functional endoscopic sinus surgery for medically refractory symptoms of CRS.
Main Outcomes and Measures: Primary outcome measures consisted of preoperative and postoperative scores operationalized by the Rhinosinusitis Disability Index (RSDI) survey, the 22-item Sinonasal Outcome Test (SNOT-22), and the Pittsburgh Sleep Quality Index (PSQI). Obstructive sleep apnea was the primary, independent risk factor.
Results: Of 405 participants, 60 (15%) had comorbid OSA. A total of 285 (70%) participants provided preoperative and postoperative survey responses, with a mean (SD) of 13.7 (5.3) months of follow-up. Significant postoperative improvement (P < .05) was reported across all mean disease-specific QOL measures for both participants with and without comorbid OSA. Participants without OSA reported significant greater improvement in unadjusted mean (SD) RSDI global scores (−25.0 [23.3] vs −16.5 [22.1]; P = .03), RSDI physical (−10.7 [9.2] vs −7.3 [9.1]; P = .03) and functional (−8.4 [8.7] vs −5.1 [7.5]; P = .03) subdomain scores, and SNOT-22 rhinologic symptom domain scores (−9.1 [7.7] vs −5.7 [6.9]; P = .008). Participants without OSA also reported greater improvements on mean (SD) PSQI global (−1.9 [4.0] vs −0.5 [3.7]; P = .03), sleep quality (−0.4 [0.8] vs −0.03 [0.7]; P = .02), and sleep disturbance (−0.4 [0.7] vs −0.1 [0.7]; P = .03) scores. The majority of these associations were found to be durable after adjustment for alternate independent cofactors using stepwise linear regression modeling.
Conclusions and Relevance: Patients with CRS and comorbid OSA have poor QOL with substantial disease-specific QOL improvements following surgery. Patients who present with CRS should be assessed for primary sleep disorders and, if identified, should be treated concurrently for both CRS and OSA to improve sleep dysfunction to optimize surgical outcomes.

JAMA material
JAMA Ortolarygology – Head and Neck Surgery abstract


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