The pain–depression dyad and the association with sleep dysfunction in chronic rhinosinusitis

Abstract

Background Depression, pain, and sleep disturbance is a symptom cluster often found in patients suffering from chronic illness, exerting a large impact on quality-of-life (QOL). A wealth of literature exists demonstrating a significant association between depression, pain, and sleep dysfunction in other chronic diseases. This relationship has not been described in patients with chronic rhinosinusitis (CRS). Methods Sixty-eight adult patients with CRS were prospectively enrolled. Patients at risk for depression were identified using the Patient Health Questionnaire-2 (PHQ-2) using a cutoff of 1 or greater. Pain experience was measured using the Brief Pain Inventory Short Form (BPI-SF) and the Short Form McGill Pain Questionnaire (SF-MPQ). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Results Forty-seven patients were at risk for depression. Significant positive correlations were found between total PSQI scores and all pain measures (R=0.38–0.61, p≤0.05) and between total PSQI scores and PHQ-2 scores (R=0.46, p<0.05). For patients at risk for depression, significant, positive correlations were found between pain measures, the total PSQI score, and the three PSQI subdomains (sleep latency, sleep quality, and daytime dysfunction; R=0.31-0.61, p<0.05). The relationship between pain and sleep dysfunction scores was not seen in the absence of depression. Conclusions Depression, pain, and sleep dysfunction are inter-related in patients with CRS. In the absence of depression significant correlations between pain and sleep are not observed, suggesting that depression plays a key role in this interaction. Further research investigating the complex relationship between depression, pain, and sleep dysfunction in CRS is needed.

Multimodal Frequency Treatment for Facial Pain Caused by Chronic Rhinosinusitis: A Pilot Study

“…Chronic rhinosinusitis symptoms can have a negative impact on quality of life [47], especially in interference with sleep [65]. Lack of sleep is correlated with depression in CRS patients [3]. In our study, patients experienced better sleep after treatment and reported improvement in overall quality of life.…”

“…Current research suggests that CRS is predominantly an inflammatory disease, with current therapies targeting inflammation within the sino-nasal cavity [2]. Symptoms of nasal congestion and facial pain significantly reduce the quality of life of CRS patients [3,4]. Many patients continue to experience pain after both medical and surgical management.…”

Incidence and burden of comorbid pain and depression in patients with chronic rhinosinusitis awaiting endoscopic sinus surgery in Canada

“…This finding is important, as the relationship between the SNOT-22 score (a condition-specific instrument) and other specific instruments designed to be sensitive to depression and pain, was previously unclear. These are important domains which have been previously reported to be inadequately measured by the SNOT-22 [21], though the effects of which have been suggested elsewhere [11, 13]. …”

“…Sino-nasal symptoms have been documented to be associated with significant anxiety and depression [10, 11]; especially in patients without polyps [11], and more than half of patients with CRS reportedly suffer from pain [12, 13]. Dysfunction of sleep and pain have been seen to be inter-related in the presence of depression [13]. However, very little is known about the health status of those patients with CRS on the wait list for ESS, representing a significant knowledge gap that can impair clinical decision making.…”

Sleep disruption in chronic rhinosinusitis

“…In this study, positive correlations were found between pain measures and total PSQI score or the 3 PSQI subdomains that measure sleep latency, sleep quality, and daytime dysfunction (all p values < 0.05). Interestingly, the link between sleep dysfunction and pain was limited to CRS patients who were at risk for depression, indicative of the clustering of these major symptoms in CRS [29]. …”