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Sleep and quality of life improvements after endoscopic sinus surgery in patients with chronic rhinosinusitis
Author(s) -
Alt Jeremiah A.,
Smith Timothy L.,
Schlosser Rodney J.,
Mace Jess C.,
Soler Zachary M.
Publication year - 2014
Publication title -
international forum of allergy and rhinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.503
H-Index - 46
eISSN - 2042-6984
pISSN - 2042-6976
DOI - 10.1002/alr.21364
Subject(s) - medicine , pittsburgh sleep quality index , confidence interval , chronic rhinosinusitis , odds ratio , quality of life (healthcare) , sinusitis , physical therapy , surgery , sleep quality , insomnia , nursing , psychiatry
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.