Sleep Apnea and Sinus Surgery

nasal polyp cat scan for sinus surgery and sleep apnea

Cat scan of Nasal Polyps

Chronic rhinosinusitis (CRS) may present as a prolonged (twelve weeks or longer) period in which a patient suffers consistent nasal congestion, facial pain, fatigue and colored nasal discharge.1,2. However, this condition can be associated with additional symptoms, most notably the development of polyps within the nasal sinuses (or cavities of the nose)3. CRS may affect life quality in a number of ways, including disturbing sleep patterns. It may require treatment with the goal of clearing respiratory pathways and restoring normal breathing4. This may include surgery to remove polyps5.

CRS is thought to affect up to 9% of the total population6. This condition is thought to be due to inflammation of the sinuses, which may occur as a result from allergies or from infection by bacteria or viruses. There is also some evidence that suggests CRS may be due to autoimmune factors, or immune system ‘hyperreactivity’ (i.e. an illness similar to an allergy)7.

cat scan for sinus surgery and sleep apnea

Sinus Infections and Sleep Apnea

CRS may also be correlated with other conditions that are associated with sleep disruption and deprivation5. This includes sleep apnea. People who suffer from sleep apnea may experience short, infrequent or even interrupted breathing during sleep, causing them to wake up in order to start normal respiration again. As a result, this condition is also associated with health deficits related to impaired sleep quality5.

Sleep apnea may be related to direct respiratory blockage, in which cases it is known as obstructive sleep apnea (OSA). Therefore, CRS, particularly in cases with considerable nasal congestion and/or polyps, may be a source of OSA. This raises the possibility that surgical correction of CRS may have additional benefits for patients that also suffer from OSA.

Link between sinus surgery and sleep apnea

A recent study investigated this potential link between surgery for CRS and reductions in OSA. In total, 285 patients with and without OSA were included in the study. Patients reported the severity of their symptoms and their quality of life. Questons included the Sinonasal Outcome Test (or SNOT-22), the Rhinosinusitis Disability Index (RSDI), and the classic sleep-rating test, the Pittsburgh Sleep Quality Index (PSQI). The tests measured rhinosinusitis symptom severity and how this affects a patient’s sleep, emotional and social health8, functional and physical health, and sleep quality1.

Patients filled out the surveys both before and after undergoing endoscopic procedures to address nasal polyps. When analyzed, this data indicated that patients both with and without OSA experienced significant improvements in the SNOT-22 and RSDI scores following surgery5. However, when comparing the group of patients, the post-surgery improvements in SNOT-22, RSDI and PSQI scores were significantly greater in the group without apnea5. These results suggest that surgery for CRS results in significant beneficial effects on sleep quality and life quality, but to a lesser extent in patients with comorbid OSA. The researchers who wrote this original research article recommend that, based on the results of their study, candidates for CRS-related surgery are also screened for OSA, as additional procedures may be performed simultaneously to address both conditions5.

References:

  1. Alt JA, Smith TL. Chronic rhinosinusitis and sleep: a contemporary review. Int Forum Allergy Rhinol. 2013;3(11):941-949.
  2. Scadding GK, Durham SR, Mirakian R, et al. BSACI guidelines for the management of rhinosinusitis and nasal polyposis. Clin Exp Allergy. 2008;38(2):260-275.
  3. Otto BA, Wenzel SE. The role of cytokines in chronic rhinosinusitis with nasal polyps. Curr Opin Otolaryngol Head Neck Surg. 2008;16(3):270-274.
  4. Kariya S, Okano M, Oto T, et al. Pulmonary function in patients with chronic rhinosinusitis and allergic rhinitis. J Laryngol Otol. 2014;128(3):255-262.
  5. Alt JA, DeConde AS, Mace JC, Steele TO, Orlandi RR, Smith TL. Quality of Life in Patients With Chronic Rhinosinusitis and Sleep Dysfunction Undergoing Endoscopic Sinus Surgery: A Pilot Investigation of Comorbid Obstructive Sleep Apnea. JAMA otolaryngology– head & neck surgery. 2015:1-9.
  6. Lange B, Holst R, Thilsing T, Baelum J, Kjeldsen A. Quality of life and associated factors in persons with Chronic Rhinosinusitis in the general population. Clin Otolaryngol. 2013.
  7. Danielsen KA, Eskeland O, Fridrich-Aas K, Orszagh VC, Bachmann-Harildstad G, Burum-Auensen E. Bacterial biofilms in patients with chronic rhinosinusitis: a confocal scanning laser microscopy study. Rhinology. 2014;52(2):150-155.
  8. Hopkins C, Gillett S, Slack R, Lund VJ, Browne JP. Psychometric validity of the 22-item Sinonasal Outcome Test. Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery. 2009;34(5):447-454.