title: Quality-of-life improvement after endoscopic sinus surgery in patients with obstructive sleep apnea.
abstract: BACKGROUND
  There is preliminary evidence that patients with chronic rhinosinusitis (CRS) and comorbid obstructive sleep apnea (OSA) have reduced quality-of-life (QOL) improvements after functional endoscopic sinus surgery (FESS) compared with patients without OSA. The effect of OSA severity on QOL improvement after FESS is unknown.
  
  
  OBJECTIVE
  To better characterize the QOL improvement after FESS for patients with comorbid OSA and to assess whether QOL improvement is dependent on OSA severity.
  
  
  METHODS
  This multi-institution, retrospective cohort study evaluated adult patients with CRS who underwent FESS between 2007 and 2015. Preoperative, 1-month, 3-month, 6-month, and 1-year postoperative 22-Item Sino-Nasal Outcome Test scores were used to evaluate QOL. We compared patients without OSA with patients with stratified OSA based on the preoperative apnea-hypopnea index. A multilevel, mixed-effects linear regression model was used for the analysis.
  
  
  RESULTS
  Of 480 participants, 83 (17%) had OSA, and 47 of these patients had polysomnography results available for review. Both patients with OSA and patients without OSA reported significant QOL improvement after surgery (p < 0.0001) relative to baseline. In the unadjusted model, the subjects with OSA demonstrated a statistically worse outcome in 22-Item Sino-Nasal Outcome Test scores at each time point (2.4 points higher per time point, p = 0.006). When controlling for covariates, the adjusted model showed no difference in QOL outcome based on OSA status (p = 0.114). When stratified by OSA disease severity, the adjusted model showed no difference in the QOL outcome.
  
  
  CONCLUSIONS
  Patients with CRS and comorbid OSA had worse QOL outcomes after FESS; however, when controlling for patient factors, there was no difference in QOL outcome. OSA disease severity did not seem to predict QOL improvement after FESS.
authors.forename: Bobby A
authors.initials: BA
authors.lastname: Tajudeen
authors.forename: Steven G
authors.initials: SG
authors.lastname: Brooks
authors.forename: Carol H
authors.initials: CH
authors.lastname: Yan
authors.forename: Edward C
authors.initials: EC
authors.lastname: Kuan
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Schwartz
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Suh
authors.forename: James N
authors.initials: JN
authors.lastname: Palmer
authors.forename: Nithin D
authors.initials: ND
authors.lastname: Adappa