Sleep quality and disease severity in patients with chronic rhinosinusitis

Authors

  • Jeremiah A. Alt MD, PhD,

    1. Department of Otolaryngology–Head and Neck Surgery, Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Oregon Health and Science University, Portland, Oregon
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  • Timothy L. Smith MD, MPH,

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, Division of Rhinology and Sinus Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A.
    • Department of Otolaryngology–Head and Neck Surgery, Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Oregon Health and Science University, Portland, Oregon
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  • Jess C. Mace MPH,

    1. Department of Otolaryngology–Head and Neck Surgery, Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Oregon Health and Science University, Portland, Oregon
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  • Zachary M. Soler MD, MSc

    1. Department of Otolaryngology–Head and Neck Surgery, Division of Rhinology and Sinus Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A.
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  • Accepted for oral presentation at the 116th Annual Meeting of the Triological Society within the Combined Otolaryngology Spring Meetings (COSM) in Orlando, Florida, April 10–14, 2013.

  • Zachary M. Soler, MD, MSc; Jess C. Mace, MPH; and Timothy L. Smith, MD, MPH are supported by a grant from the National Institute on Deafness and Other Communication Disorders (NIDCD), one of the National Institutes of Health, Bethesda, MD (2R01 DC005805; PI: T.L. Smith). Public clinical trial registration (http://www.clinicaltrials.gov) ID£NCT01332136. Timothy L. Smith, MD is also a consultant for Intersect ENT (Palo Alto, CA), which is not affiliated in any way with this investigation. The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Send correspondence to Timothy L. Smith, MD, MPH, Oregon Health & Science University Department of Otolaryngology–Head & Neck Surgery, Division of Rhinology and Sinus Surgery, Oregon Sinus Center, 3181 SW Sam Jackson Park Road, PV-01, Portland, Oregon 97239. E-mail: smithtim@ohsu.edu

Abstract

Objectives/Hypothesis

To evaluate sleep quality in patients with chronic rhinosinusitis (CRS) using a validated outcome measure and to compare measures of CRS disease severity with sleep dysfunction.

Study Design

Cross-sectional evaluation of a multi-center cohort.

Methods

According to the 2007 Adult Sinusitis Guidelines, patients with CRS were prospectively enrolled from four academic, tertiary care centers across North America. Each subject completed the Pittsburgh Sleep Quality Index (PSQI) instrument, in addition to CRS-specific measures of quality-of-life (QOL), endoscopy, computed tomography (CT), and olfaction. Patient demographics, comorbid conditions, and clinical measures of disease severity were compared between patients with “good” (PSQI; ≤5) and “poor” (PSQI; > 5) sleep quality.

Results

Patients (n = 268) reported a mean PSQI score of 9.4 (range: 0–21). Seventy-five percent of patients reported PSQI scores above the traditional cutoff, indicating poor sleep quality. Patients with poor sleep quality were found to have significantly worse QOL scores on both the Rhinosinusitis Disability Index (P < 0.001) and 22-item Sinonasal Outcome Test (P < 0.001). No significant differences in average endoscopy, CT, or olfactory function scores were found between patients with good or poor sleep quality. Tobacco smokers reported worse average PSQI total scores compared to nonsmokers (P = 0.030). Patients reporting poor sleep were more likely to have a history of depression, even after controlling for gender (P = 0.020).

Conclusion

The majority of patients with CRS have a poor quality of sleep, as measured by the PSQI survey. Poor sleep quality is significantly associated with CRS-specific QOL, gender, comorbid depression, and tobacco use, but not CT score or endoscopy grade.

Level of Evidence

2b. Laryngoscope, 123:2364–2370, 2013

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