Changes in Sleep Quality Following Treatment for Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis

Abstract

Background Chronic rhinosinusitis (CRS) presents with broad and systemic manifestations, including impaired sleep; however, the impact of CRS treatments upon sleep is unknown. Objective To establish the effect of medical or surgical CRS treatment on subjective and objective sleep metrics for patients not previously diagnosed with sleep apnea. Methods Review of PubMed, Scopus, Web of Science, and the Cochrane Library was performed from the databases’ date of inception through August 13, 2020, for studies evaluating the effect of CRS treatment on sleep quality. All studies reporting on subjective and objective sleep parameters for patients with CRS, with completed pre- and posttreatment data were included. Studies composed of patients with diagnosed sleep apnea were excluded. Results Sixteen unique studies reporting data on a total of 1770 patients (mean age, 50.6 ± 15.6 (n = 1675) years) following treatment for CRS were included. Patient-reported outcome measures, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, and Fatigue Severity Scale, demonstrated mean posttreatment differences of −2.8 (95% CI: −4.9 to −0.7), −2.4 (95% CI: −3.7 to −1.2), and −1.2 (95% CI: −1.6 to −0.7), respectively. The SNOT-22 and its sleep domain demonstrated a mean posttreatment difference of −23.5 (95% CI: −31.7 to −15.3) and −5.4 (95% CI: −6.8 to −4.0), respectively. EpSS, FSS and SNOT-22 exceeded their respective reported MCID values. Objective findings did not significantly change with treatment; mean difference: AHI: 0.7 (95% CI: −1.5 to 2.9), oxygen nadir: 0.3 (95% CI: −0.4 to 0.9). Conclusions Treatment of CRS may lead to clinically meaningful reduction in disease burden and improvements in both overall sleep quality and patient-reported fatigue. Despite clinically meaningful quality of life improvements, objective sleep parameters did not demonstrate corresponding posttreatment improvements.

Omalizumab improves sleep and health status for patients with chronic rhinosinusitis with nasal polyps: An analysis of randomized clinical trials

“…A recent study investigated the impact of dupilumab, a monoclonal antibody inhibitor of an interleukin-4 and interleukin-13 common receptor on patients with CRSwNP: Busse et al 30 found that improvements in the SNOT-22 sleep domain scores and function domain scores were greater with dupilumab than placebo at week 24 and week 52; however, direct comparisons cannot be made as an alternative sleep domain 31 was assessed in this study. Given there are many reports of improvements in sleep quality after medical or surgical treatment for CRS, 32 our analyses provide further evidence that treatments that improve the clinical symptoms of upper respiratory tract disorders can lead to concomitant improvements in sleep.…”

Science and Research March Onward

“…Kawasumi et al assessed the paranasal sinus epithelium in patients with eosinophilic and non- eosinophilic CRS for the presence of two receptor molecules that have gained widespread interest as a result of the recent SARS-CoV-2 pandemic, given their role as the primary receptor for viral infection and transmission. 7 Furthermore, Fried and colleagues reviewed 16 studies in order to determine the effects of medical or surgical CRS treatment on sleep in patients not previously diagnosed with sleep apnea; 8 although subjective improvements were reported using quality of life measures, objective improvements in sleep metrics were not so readily apparent.…”