Sleep Dysfunction and its Association to Chronic Rhinosinusitis: Updated Review

Abstract

Background Poor sleep has significant effects on health contributing to increased morbidity and mortality. The direct and indirect costs of sleep dysfunction total well in to the billions of dollars annually in the US. Chronic rhinosinusitis (CRS) affects up to 16% of the US population and has been linked to poor sleep quality with up to three quarters of patients with CRS reporting poor sleep quality. There is a growing body of literature evaluating the relationship between sleep and CRS. In this review, we organize and present the current knowledge on the associations between sleep and CRS as well as identify areas for further investigation. Data Sources A structured literature search from 1946 to 2016 was conducted in the English language using OVID MEDLINE database, PubMed and EMBASE. Review Methods Abstracts were reviewed for relevance and appropriate studies were included in the narrative review. Results Studies were analyzed and discussed as they pertained to the following categories of CRS and sleep: (1) subjective measures of sleep dysfunction, (2) objective measures of sleep dysfunction, and (3) outcomes on sleep quality following treatment of CRS. Articles on the pathophysiology of sleep dysfunction in CRS were separately reviewed. Conclusions An evolving body of research demonstrates that quality of sleep is compromised in the majority of patients with CRS. Following treatment of CRS, there is significant improvement in subjective sleep quality, but additional research investigating objective measures following treatment is still needed. Additionally, further investigation is required to better elucidate the underlying pathophysiology of the relationship between sleep dysfunction and CRS.

Efecto de la intervención nasal y nasosinusal en calidad de sueño en el Hospital Edgardo Rebagliati Martins 2017

“…La etiología y fisiopatología exacta se desconoce pero alguna teorías señalan que estaría en relación al grado de obstrucción nasal o en el caso de sinusitis crónica, por citoquinas inflamatorias que causan alteraciones en la fase de sueño REM, que en adultos está asociada a consolidación de la memoria (4) . Dentro del sistema inmunitario, los leucocitos producen citoquinas que tienen como función ser mediadores intercelulares y parecen jugar un rol en la regulación inmunitaria y del sueño (6) . Está demostrado que dentro de los estimulantes del sueño están la interleucina (IL), el interferón alfa y el factor de necrosis tumoral-α (TNF-α).…”

“…Se ha evaluado un impacto positivo de la septoplastia y la rinoplastia (1) en calidad de sueño, que pareciera estar relacionado al grado de obstrucción nasal previa. Otros estudios respecto a la intervención nasosinusal (operación endoscópica por sinusitis crónica), sugieren que hay un efecto positivo de calidad de sueño expresada por el paciente, pero que parece estar relacionada por el grado de severidad de sinusitis crónica, o ausencia o presencia de pólipos nasales (2)(3)(4)(5)(6) .…”

“…Existe controversia sobre el mecanismo en que estos procedimientos influyen en la calidad del sueño del paciente. No está claro si la mejoría es solo por la resolución de la obstrucción nasal, por el proceso de base (desviación de tabique nasal, presencia de pólipos), o por disminución de mediadores inflamatorios sistémicos, como ocurre después de una intervención endoscópica por sinusitis crónica (6) .…”

The Influence of Functional Endoscopic Sinus Surgery on Sleep Related Outcomes in Patients with Chronic Rhinosinusitis

“…Sleep impairment is a common symptom in patients with chronic rhinosinusitis (CRS) [1–3]. Alt et al reported a 75% prevalence of poor sleep quality in 268 CRS patients, as measured by the Pittsburg Sleep Quality Index instrument [4].…”

Appropriate medical management of chronic rhinosinusitis reduces use of antibiotics and oral corticosteroids

“…[4][5][6][7][8][9] The disease leads not only to a significant health care burden, costing society billions of dollars in direct and indirect costs every year, but also causes a significant quality-of-life (QOL) detriment for affected patients. [10][11][12][13][14] Although sinonasal symptomatology associated with CRS is classically considered to be the primary driver of decreased QOL, 10,15,16 prior work has shown that the ability of CRS to exacerbate other comorbid diseases as well as the frequency of acute exacerbations of CRS (AECRS) are also important drivers of decreased QOL. 11,17,18 AECRS in particular appear to be distinct clinical manifestations of CRS that negatively affect patients, independent of CRS symptomatology.…”