Nyssa Fox Farrell1, Jess C Mace1, David A Sauer2, Andrew J Thomas3, Mathew Geltzeiler1, Kara Y Detwiller1, Jeremiah A Alt4, Timothy L Smith1. 1. Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR. 2. Department of Pathology, Oregon Health & Science University, Portland, OR. 3. Department of Otolaryngology, Oschner Health Center-West Bank, Gretna, LA. 4. Division of Otolaryngology, Department of Surgery, University of Utah, Salt Lake City, UT.
Abstract
BACKGROUND: Chronic rhinosinusitis (CRS) is associated with sleep dysfunction, but the underlying pathophysiology is poorly understood. The purpose of this study was to determine if mucosal eosinophilia or neutrophilia were associated with sleep dysfunction severity or altered the improvement in sleep dysfunction following functional endoscopic sinus surgery (FESS). METHODS: A total of 104 patients with medically refractory CRS with nasal polyposis (CRSwNP) and CRS without nasal polyposis (CRSsNP), completed the Pittsburgh Sleep Quality Index (PSQI) before and after FESS. Anterior ethmoid mucosa was collected during FESS and densest infiltrates of eosinophilia and neutrophilia per high-power field (HPF) were determined by microscopy. Eosinophilic (>10 eosinophils/HPF) and neutrophilic (>4 neutrophils/HPF) CRS were then compared to preoperative and postoperative PSQI measures. RESULTS: Of 104 study participants, 88 (85%) reported preoperative PSQI scores consistent with "poor sleep," (PSQI total > 5). The cohort overall demonstrated significant improvement in poor sleep (65%; χ2 = 12.03; p < 0.001) 16.8 ± 5.0 months after FESS. Regardless of nasal polyposis, neither eosinophilic nor neutrophilic CRS was associated with differences in mean postoperative PSQI improvement. However, in patients with neutrophilic CRSsNP, there was a significant relationship between severity of neutrophilia and improvement in sleep latency (R = -0.798, p = 0.003) and sleep efficacy (R = -0.777, p = 0.005). CONCLUSION: Chronic inflammation has been hypothesized to play a pathophysiologic role in sleep dysfunction associated with CRS. This study suggests that in patients with medically refractory CRS, evidence of mucosal eosinophilia and neutrophilia lack strong associations with patient-reported sleep dysfunction or improvements in sleep quality after FESS, overall. However, neutrophilia may impact sleep latency and efficacy in patients with CRSsNP.
BACKGROUND: Chronic rhinosinusitis (CRS) is associated with sleep dysfunction, but the underlying pathophysiology is poorly understood. The purpose of this study was to determine if mucosal eosinophilia or neutrophilia were associated with sleep dysfunction severity or altered the improvement in sleep dysfunction following functional endoscopic sinus surgery (FESS). METHODS: A total of 104 patients with medically refractory CRS with nasal polyposis (CRSwNP) and CRS without nasal polyposis (CRSsNP), completed the Pittsburgh Sleep Quality Index (PSQI) before and after FESS. Anterior ethmoid mucosa was collected during FESS and densest infiltrates of eosinophilia and neutrophilia per high-power field (HPF) were determined by microscopy. Eosinophilic (>10 eosinophils/HPF) and neutrophilic (>4 neutrophils/HPF) CRS were then compared to preoperative and postoperative PSQI measures. RESULTS: Of 104 study participants, 88 (85%) reported preoperative PSQI scores consistent with "poor sleep," (PSQI total > 5). The cohort overall demonstrated significant improvement in poor sleep (65%; χ2 = 12.03; p < 0.001) 16.8 ± 5.0 months after FESS. Regardless of nasal polyposis, neither eosinophilic nor neutrophilic CRS was associated with differences in mean postoperative PSQI improvement. However, in patients with neutrophilic CRSsNP, there was a significant relationship between severity of neutrophilia and improvement in sleep latency (R = -0.798, p = 0.003) and sleep efficacy (R = -0.777, p = 0.005). CONCLUSION: Chronic inflammation has been hypothesized to play a pathophysiologic role in sleep dysfunction associated with CRS. This study suggests that in patients with medically refractory CRS, evidence of mucosal eosinophilia and neutrophilia lack strong associations with patient-reported sleep dysfunction or improvements in sleep quality after FESS, overall. However, neutrophilia may impact sleep latency and efficacy in patients with CRSsNP.
Authors: Richard R Orlandi; Todd T Kingdom; Peter H Hwang; Timothy L Smith; Jeremiah A Alt; Fuad M Baroody; Pete S Batra; Manuel Bernal-Sprekelsen; Neil Bhattacharyya; Rakesh K Chandra; Alexander Chiu; Martin J Citardi; Noam A Cohen; John DelGaudio; Martin Desrosiers; Hun-Jong Dhong; Richard Douglas; Berrylin Ferguson; Wytske J Fokkens; Christos Georgalas; Andrew Goldberg; Jan Gosepath; Daniel L Hamilos; Joseph K Han; Richard Harvey; Peter Hellings; Claire Hopkins; Roger Jankowski; Amin R Javer; Robert Kern; Stilianos Kountakis; Marek L Kowalski; Andrew Lane; Donald C Lanza; Richard Lebowitz; Heung-Man Lee; Sandra Y Lin; Valerie Lund; Amber Luong; Wolf Mann; Bradley F Marple; Kevin C McMains; Ralph Metson; Robert Naclerio; Jayakar V Nayak; Nobuyoshi Otori; James N Palmer; Sanjay R Parikh; Desiderio Passali; Anju Peters; Jay Piccirillo; David M Poetker; Alkis J Psaltis; Hassan H Ramadan; Vijay R Ramakrishnan; Herbert Riechelmann; Hwan-Jung Roh; Luke Rudmik; Raymond Sacks; Rodney J Schlosser; Brent A Senior; Raj Sindwani; James A Stankiewicz; Michael Stewart; Bruce K Tan; Elina Toskala; Richard Voegels; De Yun Wang; Erik K Weitzel; Sarah Wise; Bradford A Woodworth; Peter-John Wormald; Erin D Wright; Bing Zhou; David W Kennedy Journal: Int Forum Allergy Rhinol Date: 2016-02 Impact factor: 3.858
Authors: Elias A Said; Mohammed A Al-Abri; Iman Al-Saidi; Mohammed S Al-Balushi; Jumaa Z Al-Busaidi; Iman Al-Reesi; Crystal Y Koh; Mohamed A Idris; Ali A Al-Jabri; Omar Habbal Journal: Sleep Breath Date: 2019-04-30 Impact factor: 2.816
Authors: Daniel Sharbel; Mingsi Li; Aykut A Unsal; Sandra Y Tadros; Jason Lee; Paul Biddinger; Thomas Holmes; Stilianos E Kountakis Journal: Int Forum Allergy Rhinol Date: 2020-01-12 Impact factor: 3.858
Authors: Maree A Milross; Amanda J Piper; Mark Norman; Catherine J Dobbin; Ronald R Grunstein; Colin E Sullivan; Peter T P Bye Journal: Sleep Med Date: 2002-05 Impact factor: 3.492