title: Improvements in sleep-related symptoms after endoscopic sinus surgery in patients with chronic rhinosinusitis.
abstract: BACKGROUND
  Sleep impairment is highly prevalent in patients with chronic rhinosinusitis (CRS). Although endoscopic sinus surgery (ESS) has been shown to improve overall patient-reported sleep quality, the postoperative impact on individual sleep symptoms remains unclear.
  
  
  METHODS
  Patients with medically-recalcitrant CRS who elected to undergo ESS were prospectively enrolled into a multi-institutional, observational cohort study. Sleep-related symptom severity and treatment outcomes were assessed using the sleep domain questions within the 22-item Sino-Nasal Outcome Test (SNOT-22).
  
  
  RESULTS
  A total of 334 participants met criteria and were followed postoperatively for an average of 14.5 ± 4.9 months (mean ± standard deviation [SD]). Mean SNOT-22 sleep domain scores improved from 13.7 ± 6.8 to 7.7 ± 6.6 (p < 0.001). Significant mean relative improvements were reported for "difficulty falling asleep" (45%; p < 0.001), "waking up at night" (40%; p < 0.001), "lack of a good night's sleep" (43%; p < 0.001), "waking up tired" (40%; p < 0.001), and "fatigue" (42%; p < 0.001) scores. A total of 66% of study participants reported postoperative improvement in "lack of a good night's sleep," "waking up tired," and "fatigue"; 62% reported improvement in "waking up at night"; and 58% reported improvement in "difficulty falling asleep."
  
  
  CONCLUSIONS
  Patients with CRS report significant and sustained improvements following ESS in common sleep-related symptoms as assessed by the SNOT-22 sleep domain. Despite these significant improvements, some degree of persistent postoperative sleep impairment was reported. Further study is necessary to determine what factors are associated with continued sleep dysfunction after sinus surgery.
authors.affiliation: Division of Rhinology and Sinus/Skull Base Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery; Oregon Health and Science University, Portland, OR.
authors.forename: Edward
authors.initials: E
authors.lastname: El Rassi
authors.affiliation: Division of Rhinology and Sinus/Skull Base Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery; Oregon Health and Science University, Portland, OR.
authors.forename: Jess C
authors.initials: JC
authors.lastname: Mace
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, CA.
authors.forename: Toby O
authors.initials: TO
authors.lastname: Steele
authors.affiliation: Division of Head and Neck Surgery, Rhinology-Sinus and Skull Base Surgery Program, Department of Surgery, University of Utah, Salt Lake City, UT.
authors.forename: Jeremiah A
authors.initials: JA
authors.lastname: Alt
authors.affiliation: Division of Rhinology and Sinus/Skull Base Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery; Oregon Health and Science University, Portland, OR.
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010256:Paranasal Sinuses / Q000601:surgery*; D011184:Postoperative Period; D011788:Quality of Life; D012220:Rhinitis / Q000601:surgery*; D012852:Sinusitis / Q000601:surgery*; D012893:Sleep Wake Disorders / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: endoscopic sinus surgery; patient outcome assessment; sinusitis; sleep; treatment outcome