Edward El Rassi1, Jess C Mace1, Toby O Steele2, Jeremiah A Alt3, Timothy L Smith1. 1. Division of Rhinology and Sinus/Skull Base Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery; Oregon Health and Science University, Portland, OR. 2. Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, CA. 3. Division of Head and Neck Surgery, Rhinology-Sinus and Skull Base Surgery Program, Department of Surgery, University of Utah, Salt Lake City, UT.
Abstract
BACKGROUND: Sleep impairment is highly prevalent in patients with chronic rhinosinusitis (CRS). Although endoscopic sinus surgery (ESS) has been shown to improve overall patient-reported sleep quality, the postoperative impact on individual sleep symptoms remains unclear. METHODS: Patients with medically-recalcitrant CRS who elected to undergo ESS were prospectively enrolled into a multi-institutional, observational cohort study. Sleep-related symptom severity and treatment outcomes were assessed using the sleep domain questions within the 22-item Sino-Nasal Outcome Test (SNOT-22). RESULTS: A total of 334 participants met criteria and were followed postoperatively for an average of 14.5 ± 4.9 months (mean ± standard deviation [SD]). Mean SNOT-22 sleep domain scores improved from 13.7 ± 6.8 to 7.7 ± 6.6 (p < 0.001). Significant mean relative improvements were reported for "difficulty falling asleep" (45%; p < 0.001), "waking up at night" (40%; p < 0.001), "lack of a good night's sleep" (43%; p < 0.001), "waking up tired" (40%; p < 0.001), and "fatigue" (42%; p < 0.001) scores. A total of 66% of study participants reported postoperative improvement in "lack of a good night's sleep," "waking up tired," and "fatigue"; 62% reported improvement in "waking up at night"; and 58% reported improvement in "difficulty falling asleep." CONCLUSION: Patients with CRS report significant and sustained improvements following ESS in common sleep-related symptoms as assessed by the SNOT-22 sleep domain. Despite these significant improvements, some degree of persistent postoperative sleep impairment was reported. Further study is necessary to determine what factors are associated with continued sleep dysfunction after sinus surgery.
BACKGROUND:Sleep impairment is highly prevalent in patients with chronic rhinosinusitis (CRS). Although endoscopic sinus surgery (ESS) has been shown to improve overall patient-reported sleep quality, the postoperative impact on individual sleep symptoms remains unclear. METHODS:Patients with medically-recalcitrant CRS who elected to undergo ESS were prospectively enrolled into a multi-institutional, observational cohort study. Sleep-related symptom severity and treatment outcomes were assessed using the sleep domain questions within the 22-item Sino-Nasal Outcome Test (SNOT-22). RESULTS: A total of 334 participants met criteria and were followed postoperatively for an average of 14.5 ± 4.9 months (mean ± standard deviation [SD]). Mean SNOT-22 sleep domain scores improved from 13.7 ± 6.8 to 7.7 ± 6.6 (p < 0.001). Significant mean relative improvements were reported for "difficulty falling asleep" (45%; p < 0.001), "waking up at night" (40%; p < 0.001), "lack of a good night's sleep" (43%; p < 0.001), "waking up tired" (40%; p < 0.001), and "fatigue" (42%; p < 0.001) scores. A total of 66% of study participants reported postoperative improvement in "lack of a good night's sleep," "waking up tired," and "fatigue"; 62% reported improvement in "waking up at night"; and 58% reported improvement in "difficulty falling asleep." CONCLUSION:Patients with CRS report significant and sustained improvements following ESS in common sleep-related symptoms as assessed by the SNOT-22 sleep domain. Despite these significant improvements, some degree of persistent postoperative sleep impairment was reported. Further study is necessary to determine what factors are associated with continued sleep dysfunction after sinus surgery.
Authors: Adam S DeConde; Jess C Mace; Shaelene Ashby; Timothy L Smith; Richard R Orlandi; Jeremiah A Alt Journal: Int Forum Allergy Rhinol Date: 2015-06-13 Impact factor: 3.858
Authors: Jeremiah A Alt; Adam S DeConde; Jess C Mace; Toby O Steele; Richard R Orlandi; Timothy L Smith Journal: JAMA Otolaryngol Head Neck Surg Date: 2015-10 Impact factor: 8.961
Authors: Daniel M Beswick; Jess C Mace; Naweed I Chowdhury; Jeremiah A Alt; Peter H Hwang; Adam S DeConde; Timothy L Smith Journal: Int Forum Allergy Rhinol Date: 2017-09-22 Impact factor: 3.858
Authors: Joshua M Levy; Jess C Mace; Adam S DeConde; Toby O Steele; Timothy L Smith Journal: Int Forum Allergy Rhinol Date: 2016-04-15 Impact factor: 3.858
Authors: N R Rowan; Z M Soler; J C Mace; M P Camilon; C Palmer; R H Jones; T L Smith; R J Schlosser Journal: Rhinology Date: 2020-08-01 Impact factor: 3.681
Authors: Naweed I Chowdhury; Jess C Mace; Todd E Bodner; Jeremiah A Alt; Adam S Deconde; Joshua M Levy; Timothy L Smith Journal: Laryngoscope Date: 2018-09-12 Impact factor: 3.325
Authors: Manuela Dowsley A Guttemberg; Fabiana A Figueiredo da Mata; Márcio Nakanishi; Keitty R C de Andrade; Maurício G Pereira Journal: Braz J Otorhinolaryngol Date: 2019-07-29