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Original Investigation |

Quality of Life in Patients With Chronic Rhinosinusitis and Sleep Dysfunction Undergoing Endoscopic Sinus Surgery A Pilot Investigation of Comorbid Obstructive Sleep Apnea

Jeremiah A. Alt, MD, PhD1; Adam S. DeConde, MD2; Jess C. Mace, MPH3; Toby O. Steele, MD3; Richard R. Orlandi, MD1; Timothy L. Smith, MD, MPH3
[+] Author Affiliations
1Division of Head and Neck Surgery, Rhinology–Sinus and Skull Base Surgery Program, Department of Surgery, University of Utah, Salt Lake City
2Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California, San Diego
3Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland
JAMA Otolaryngol Head Neck Surg. 2015;141(10):873-881. doi:10.1001/jamaoto.2015.1673.
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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.

Trial Registration  clinicaltrials.gov Identifier: NCT01332136

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