The pain-depression dyad and the association with sleep dysfunction in chronic rhinosinusitis

Daniel R. Cox, Shaelene Ashby, Jess C. Mace, John M. Delgaudio, Timothy Smith, Richard R. Orlandi, Jeremiah A. Alt

Research output: Contribution to journalArticle

13 Scopus citations


Background: Depression, pain, and sleep disturbance is a symptom cluster often found in patients with chronic illness, exerting a large impact on quality of life (QOL). A wealth of literature exists demonstrating a significant association between depression, pain, and sleep dysfunction in other chronic diseases. This relationship has not been described in patients with chronic rhinosinusitis (CRS). Methods: Sixty-eight adult patients with CRS were prospectively enrolled. Patients at risk for depression were identified using the Patient Health Questionnaire-2 (PHQ-2) using a cut-off score of ≥1. Pain experience was measured using the Brief Pain Inventory Short Form (BPI-SF) and the Short Form McGill Pain Questionnaire (SF-MPQ). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Results: Forty-seven patients were at risk for depression. Significant positive correlations were found between total PSQI scores and all pain measures (R = 0.38-0.61, p ≤ 0.05) and between total PSQI scores and PHQ-2 scores (R = 0.46, p < 0.05). For patients at risk for depression, significant, positive correlations were found between pain measures, the total PSQI score, and the 3 PSQI subdomains (sleep latency, sleep quality, and daytime dysfunction; R = 0.31-0.61, p < 0.05). The relationship between pain and sleep dysfunction scores was not seen in the absence of depression. Conclusion: Depression, pain, and sleep dysfunction are interrelated in patients with CRS. In the absence of depression, significant correlations between pain and sleep are not observed, suggesting that depression plays a key role in this interaction. Further research is needed to investigate the complex relationship between depression, pain, and sleep dysfunction in CRS.

Original languageEnglish (US)
JournalInternational Forum of Allergy and Rhinology
StateAccepted/In press - 2016



  • Chronic disease
  • Depression
  • Outcome assessment
  • Pain
  • Sinusitis
  • Sleep

ASJC Scopus subject areas

  • Immunology and Allergy
  • Otorhinolaryngology

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