Sleep and quality of life improvements after endoscopic sinus surgery in patients with chronic rhinosinusitis

Jeremiah A. Alt, Timothy Smith, Rodney J. Schlosser, Jess C. Mace, Zachary M. Soler

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Background: Recent investigation has demonstrated that approximately 75% of patients with medically refractory chronic rhinosinusitis (CRS) report abnormal sleep quality, with strong correlation between worse sleep quality and more severe CRS disease severity. It remains unknown whether the treatment effect of endoscopic sinus surgery (ESS) for CRS results in appreciable sleep quality improvements. Methods: Adult patients (aged ≥18 years) with a current diagnosis of recalcitrant chronic rhinosinusitis (CRS), who voluntarily elected ESS as the next treatment modality (n = 301), were prospectively evaluated within 4 academic, tertiary care centers using treatment outcome instruments: the Rhinosinusitis Disability Index, the 22-item Sinonasal Outcome Test, the 2-item Patient Health Questionnaire, and the Pittsburgh Sleep Quality Index (PSQI) both before and after ESS. Results: Seventy-two percent (72%) of patients with CRS were found to have poor sleep (PSQI > 5) at baseline with a mean (standard deviation) global PSQI score of 9.4 (4.6). Surgery improved overall mean global PSQI scores (by 2.2 points), and all 7 subdomain scores of the PSQI. Similarly, the odds of good sleep quality (PSQI ≤ 5) in patients treated with sinus surgery increased significantly (odds ratio [OR] 5.94; 95% confidence interval [CI], 3.06 to 11.53; p <0.001). Stepwise multivariate linear regression found that acetylsalicylic acid (ASA) intolerance (β [standard error], -1.94 [0.93]; 95% CI, -3.77 to -0.11; p = 0.038), history of prior sinus surgery (β [standard error], 1.10 (0.54); 95% CI, 0.03 to 2.16; p = 0.044), and frontal sinusotomy (β [standard error], -1.03 [0.62]; 95% CI, -2.26 to 0.20; p = 0.099) were found to significantly associate with improvement in PSQI sleep scores. Conclusion: Among patients with CRS, reduced sleep quality, poor disease-specific quality of life, and greater disease severity were improved following ESS. 2014 ARS-AAOA, LLC.

Original languageEnglish (US)
Pages (from-to)693-701
Number of pages9
JournalInternational Forum of Allergy and Rhinology
Volume4
Issue number9
DOIs
StatePublished - 2014

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Quality Improvement
Sleep
Quality of Life
Confidence Intervals
Tertiary Care Centers
Aspirin
Linear Models
Chronic Disease
Odds Ratio

Keywords

  • Chronic disease
  • Endoscopic sinus surgery
  • Quality of life
  • Rhinitis
  • Rhinosinusitis
  • Sinusitis
  • Sleep

ASJC Scopus subject areas

  • Immunology and Allergy
  • Otorhinolaryngology
  • Medicine(all)

Cite this

Sleep and quality of life improvements after endoscopic sinus surgery in patients with chronic rhinosinusitis. / Alt, Jeremiah A.; Smith, Timothy; Schlosser, Rodney J.; Mace, Jess C.; Soler, Zachary M.

In: International Forum of Allergy and Rhinology, Vol. 4, No. 9, 2014, p. 693-701.

Research output: Contribution to journalArticle

Alt, Jeremiah A. ; Smith, Timothy ; Schlosser, Rodney J. ; Mace, Jess C. ; Soler, Zachary M. / Sleep and quality of life improvements after endoscopic sinus surgery in patients with chronic rhinosinusitis. In: International Forum of Allergy and Rhinology. 2014 ; Vol. 4, No. 9. pp. 693-701.
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abstract = "Background: Recent investigation has demonstrated that approximately 75{\%} of patients with medically refractory chronic rhinosinusitis (CRS) report abnormal sleep quality, with strong correlation between worse sleep quality and more severe CRS disease severity. It remains unknown whether the treatment effect of endoscopic sinus surgery (ESS) for CRS results in appreciable sleep quality improvements. Methods: Adult patients (aged ≥18 years) with a current diagnosis of recalcitrant chronic rhinosinusitis (CRS), who voluntarily elected ESS as the next treatment modality (n = 301), were prospectively evaluated within 4 academic, tertiary care centers using treatment outcome instruments: the Rhinosinusitis Disability Index, the 22-item Sinonasal Outcome Test, the 2-item Patient Health Questionnaire, and the Pittsburgh Sleep Quality Index (PSQI) both before and after ESS. Results: Seventy-two percent (72{\%}) of patients with CRS were found to have poor sleep (PSQI > 5) at baseline with a mean (standard deviation) global PSQI score of 9.4 (4.6). Surgery improved overall mean global PSQI scores (by 2.2 points), and all 7 subdomain scores of the PSQI. Similarly, the odds of good sleep quality (PSQI ≤ 5) in patients treated with sinus surgery increased significantly (odds ratio [OR] 5.94; 95{\%} confidence interval [CI], 3.06 to 11.53; p <0.001). Stepwise multivariate linear regression found that acetylsalicylic acid (ASA) intolerance (β [standard error], -1.94 [0.93]; 95{\%} CI, -3.77 to -0.11; p = 0.038), history of prior sinus surgery (β [standard error], 1.10 (0.54); 95{\%} CI, 0.03 to 2.16; p = 0.044), and frontal sinusotomy (β [standard error], -1.03 [0.62]; 95{\%} CI, -2.26 to 0.20; p = 0.099) were found to significantly associate with improvement in PSQI sleep scores. Conclusion: Among patients with CRS, reduced sleep quality, poor disease-specific quality of life, and greater disease severity were improved following ESS. 2014 ARS-AAOA, LLC.",
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AU - Soler, Zachary M.

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N2 - Background: Recent investigation has demonstrated that approximately 75% of patients with medically refractory chronic rhinosinusitis (CRS) report abnormal sleep quality, with strong correlation between worse sleep quality and more severe CRS disease severity. It remains unknown whether the treatment effect of endoscopic sinus surgery (ESS) for CRS results in appreciable sleep quality improvements. Methods: Adult patients (aged ≥18 years) with a current diagnosis of recalcitrant chronic rhinosinusitis (CRS), who voluntarily elected ESS as the next treatment modality (n = 301), were prospectively evaluated within 4 academic, tertiary care centers using treatment outcome instruments: the Rhinosinusitis Disability Index, the 22-item Sinonasal Outcome Test, the 2-item Patient Health Questionnaire, and the Pittsburgh Sleep Quality Index (PSQI) both before and after ESS. Results: Seventy-two percent (72%) of patients with CRS were found to have poor sleep (PSQI > 5) at baseline with a mean (standard deviation) global PSQI score of 9.4 (4.6). Surgery improved overall mean global PSQI scores (by 2.2 points), and all 7 subdomain scores of the PSQI. Similarly, the odds of good sleep quality (PSQI ≤ 5) in patients treated with sinus surgery increased significantly (odds ratio [OR] 5.94; 95% confidence interval [CI], 3.06 to 11.53; p <0.001). Stepwise multivariate linear regression found that acetylsalicylic acid (ASA) intolerance (β [standard error], -1.94 [0.93]; 95% CI, -3.77 to -0.11; p = 0.038), history of prior sinus surgery (β [standard error], 1.10 (0.54); 95% CI, 0.03 to 2.16; p = 0.044), and frontal sinusotomy (β [standard error], -1.03 [0.62]; 95% CI, -2.26 to 0.20; p = 0.099) were found to significantly associate with improvement in PSQI sleep scores. Conclusion: Among patients with CRS, reduced sleep quality, poor disease-specific quality of life, and greater disease severity were improved following ESS. 2014 ARS-AAOA, LLC.

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