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Surgery improves quality of life for individuals with chronic rhinosinusitis, comorbid OSA

Surgery considerably improved quality of life among patients with chronic rhinosinusitis and comorbid obstructive sleep apnea, according to study results.

However, individuals who had chronic rhinosinusitis without comorbid obstructive sleep apnea (OSA) derived the greatest benefit from surgery, results showed.

Individuals with chronic rhinosinusitis often have poorer sleep quality due to their overall well-being and disease-specific quality of life. Additional primary sleep disorders also can hinder quality of life, according to study background.

Timothy L. Smith, MD, MPH, of the division of rhinology and sinus/skull base surgery at Oregon Health & Science University, and colleagues conducted a prospective multisite cohort study to assess the effects of comorbid OSA on chronic rhinosinusitis-specific quality of life and sleep function among patients with chronic rhinosinusitis who underwent functional endoscopic sinus surgery.

The analysis included 405 adults who underwent surgery between October 2011 and November 2014 at academic, tertiary referral centers. Improvement from preoperative to postoperative scores measured by three standards — the Rhinosinusitis Disability Index survey, the 22-item Sinonasal Outcome Test and the Pittsburgh Sleep Quality Index — served as the primary outcome measure.

Sixty (15%) of the study participants had comorbid OSA. At baseline, researchers reported no difference between those with OSA and those without OSA with regard to chronic rhinosinusitis severity or disease-specific quality of life, poor sleep or average sleep quality scores.

A majority of participants (70%) responded to preoperative and postoperative surveys. Mean follow-up was 13.7 months.

Results showed statistically significant postoperative improvement among participants with and without comorbid OSA with regard to all mean disease-specific quality-of-life measures.

However, participants who did not have OSA demonstrated significantly greater improvement in unadjusted mean Rhinosinusitis Disability Index survey global scores (–25 vs. –16.5; P = .03), physical subdomain scores (–10.7 vs. –7.3; P = .03) and functional subdomain scores (–8.4 vs. –5.1; P = .03).

Individuals without OSA reported significantly greater improvement in rhinologic symptom domain scores on the 22-item Sinonasal Outcome Test (–9.1 vs. –5.7; P = .008).

Those without OSA also demonstrated greater improvement in mean Pittsburgh Sleep Quality Index global scores (–1.9 vs. –0.5; P = .03), sleep quality scores (–0.4 vs. –0.03; P = .02) and sleep disturbance scores (–0.4 vs. –0.1; P = .03).

Stepwise linear regression modeling adjusted for alternate independent cofactors showed most of these associations were durable, the researchers wrote.

“Patients with OSA should be treated concurrently for both chronic rhinosinusitis and OSA to optimize sleep dysfunction and quality-of-life improvement,” Smith and colleagues wrote. “Future investigations are needed to further elucidate the discordance and underlying mechanisms of sleep improvement between those patients with and without OSA with objective sleep measures.”– by Mark Leiser

Disclosure: The researchers report consultant roles with Intersect ENT and Medtronic ENT.