title: Sleep and quality of life improvements after endoscopic sinus surgery in patients with chronic rhinosinusitis.
abstract: 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.
  
  
  CONCLUSIONS
  Among patients with CRS, reduced sleep quality, poor disease-specific quality of life, and greater disease severity were improved following ESS.
authors: Division of Head and Neck Surgery, Rhinology-Sinus and Skull Base Surgery Program, Department of Surgery; University of Utah, Salt Lake City, UT.
authors: Jeremiah A
authors: JA
authors: Alt
authors: Timothy L
authors: TL
authors: Smith
authors: Rodney J
authors: RJ
authors: Schlosser
authors: Jess C
authors: JC
authors: Mace
authors: Zachary M
authors: ZM
authors: Soler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta; D002140:California; D002908:Chronic Disease; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009922:Oregon; D011788:Quality of Life; D012220:Rhinitis / Q000453:epidemiology / Q000601:surgery*; D012852:Sinusitis / Q000453:epidemiology / Q000601:surgery*; D012893:Sleep Wake Disorders / Q000453:epidemiology*; D013022:South Carolina; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: chronic disease; endoscopic sinus surgery; quality of life; rhinitis; rhinosinusitis; sinusitis; sleep