Rhinologic disease and its impact on sleep: a systematic review

Abstract

Background Rhinologic disease can be responsible for systemic symptoms affecting mood, cognition, and sleep. It is unclear whether sleep disturbance in specific rhinologic disorders (chronic rhinosinusitis [CRS], rhinitis, and nasal septal deviation [NSD]) is an obstructive phenomenon or due to other mechanisms. In this review we examine the impact of CRS, rhinitis, and NSD on objective and subjective sleep outcome metrics and draw comparisons to normal controls and patients with known obstructive sleep apnea (OSA). Methods A systematic review of 4 databases (PubMed, Scopus, Cochrane Library, and Web of Science) was performed. Studies reporting on objective (apnea‐hypopnea index [AHI], respiratory disturbance index [RDI], oxygen nadir) and subjective (Epworth Sleepiness Scale [EpSS], Pittsburgh Sleep Quality Index [PSQI], Fatigue Severity Scale [FSS]) sleep parameters and disease‐specific patient‐reported outcome measures (PROMs; 22‐item Sino‐Nasal Outcome Test [SNOT‐22], Rhinoconjunctivitis Quality of Life Questionnaire [RQLQ], Nasal Obstruction Symptom Evaluation [NOSE]) were included. Results The database search yielded 1414 unique articles, of which 103 were included for analysis. Baseline PROMs were at the high end of normal to abnormal for all 3 conditions: EpSS: CRS (9.8 ± 4.0), rhinitis (9.7 ± 4.3), and NSD (8.9 ± 4.6); and PSQI: CRS (11.0 ± 4.5), rhinitis (6.1 ± 3.7), and NSD (8.6 ± 3.5). Objective measures demonstrated a mild to moderate OSA in the studied diseases: AHI: CRS (10.4 ± 11.5), rhinitis (8.6 ± 8.8), and NSD (13.0 ± 6.9). There were significant differences when compared with reported norms in all measured outcomes (p < 0.001). Conclusion Sleep quality is impacted by rhinologic (CRS, rhinitis, NSD) disease. There is likely a mild obstructive component contributing to poor sleep, but other contributing factors may be involved.

Sleep Subdomain of the Sinonasal Outcome Test as a Potential Screening Tool for Sleep Apnea in Chronic Rhinosinusitis

“…Few studies focus on the Sleep‐SNOT subdomain alone. A recent systematic analysis demonstrated that for CRS patients, the Sleep‐SNOT is elevated to an average of 13.8 21 . The results of this study demonstrate higher mean Sleep‐SNOT scores for both OSA and non‐OSA patients.…”

“…Inflammatory mediators have been identified systemically in OSA patients, including IL's 1, 6 and 8, and TNF‐α; CRS shares many related cytokines in its pathophysiology 14,20 . Conversely, presence of obstructive and/or inflammatory rhinologic disorders has been shown to affect subjective and objective sleep metrics 21 . Inflammation or obstruction within the nose results in obligate oral breathing and can predispose patients to, or worsen existing OSA 13 .…”

Sleep impairment in patients with empty nose syndrome

“…These findings also emphasize screening for these conditions and structuring care around both surgical reconstruction and cognitive-behavioural therapy, according to the patients' situation, through collaboration with specialists in sleep, psychiatry, and psychology, for optimal outcomes. Previous studies have demonstrated that rhinologic disorders such as nasal septal deviation, allergic rhinitis, and chronic rhinosinusitis have been shown to cause extensive sleep impairment (20) . Treatment of these rhinologic disorders may lead to clinically meaningful reductions in disease burden and improvements in both overall sleep quality and patient-reported fatigue (21) .…”

Year in review: 2021 IFAR article summary

“…The degree of impact of sinonasal disease on measures of sleep has long been acknowledged by patients and is oftentimes attributed to nasal congestion, but the degree of objective impact on sleep has been debated. To investigate this area, Fried et al 17 performed a systematic review with meta-analysis and demonstrated that CRS, rhinitis, and septal deviation were all associated with perturbations in sleep quality, but the obstructive component appeared mild. Further adding to this topic area, a multicenter prospective study by Little et al 18 demonstrated that objective sleep indices were not improved after ESS for CRS, despite improvements in patient-reported sleep quality and disease-specific QoL.…”

“…The degree of impact of sinonasal disease on measures of sleep has long been acknowledged by patients and is oftentimes attributed to nasal congestion, but the degree of objective impact on sleep has been debated. To investigate this area, Fried et al 17 . performed a systematic review with meta‐analysis and demonstrated that CRS, rhinitis, and septal deviation were all associated with perturbations in sleep quality, but the obstructive component appeared mild.…”