Rhinosinusitis and OSA: can surgery improve sleep?

By Jane Lewis
A US pilot study has found that endoscopic sinus surgery in patients with chronic rhinosinusitis and comorbid obstructive sleep apnoea (OSA) can substantially improve quality of life (QoL), but not necessarily sleep quality. Such patients need to be treated concurrently for both conditions to improve sleep and optimise surgical outcomes, the authors concluded.

‘This is a huge clinical area,’ Associate Professor Melville da Cruz, ENT surgeon at Westmead and Westmead Private Hospitals in Sydney, told Medicine Today. ‘In Australia, as in the USA, chronic rhinosinusitis and OSA are both extremely common, and they coincide very frequently.’

According to the study’s authors, while functional endoscopic sinus surgery (FESS) in patients with chronic rhinosinusitis is known to lead to lasting improvements in chronic rhinosinusitis­ specific QoL, it is not clear whether similar improvements can be achieved in patients with comorbid OSA.

Published in JAMA Otolaryngology Head & Neck Surgery, the prospective multisite cohort study comprised 405 patients with medically refractory chronic rhinosinusitis, 60 (15%) of whom had comorbid OSA. A total of 285 participants completed two disease­ specific QoL surveys and one general sleep quality survey, before and after surgery. They were then followed up for a mean 13.7 months.

Before surgery, both patient subgroups – those with chronic rhinosinusitis but no OSA, and those with chronic rhinosinusitis and OSA – were comparable in terms of disease­ specific QoL, disease severity, and prevalence of poor sleep (PSQI score >5). After surgery, both groups experienced significant gains in disease severity and all disease ­specific QoL measures. However, only participants without OSA reported statistically significant sleep quality score improvement.

‘Future investigations are needed to further elucidate the discordance and underlying mechanisms of sleep improvement between those patients with and without OSA with objective sleep measures,’ the authors concluded. 

According to Associate Professor da Cruz, although chronic rhinosinusitis and OSA often coexist, they have quite different aetiologies and require different treatments. 

‘While overall quality of life may be better in patients with chronic rhinosinusitis and OSA following surgery, as these results show, when you look specifically at sleep, it is not much improved. One of the main reasons for that is likely to be that there are a whole range of factors that affect sleep quality, from obesity to allergies,’ he said.

JAMA Otolaryngol Head Neck Surg 2015; doi: 10.1001/jamaoto.2015.1673.