CME: Endoscopic Sinus Surgery & Sleep Dysfunction

CME: Endoscopic Sinus Surgery & Sleep Dysfunction
Author Information (click to view)

Timothy L. Smith, MD, MPH

Professor, Department of Otolaryngology-Head and Neck Surgery
Chief, Division of Rhinology and Sinus/Skull Base Surgery
Director, Oregon Sinus Center
Oregon Health & Science University

Timothy L. Smith, MD, MPH, has indicated to Physician’s Weekly that he has or has had no financial interests to report that are related to this research

Figure 1 (click to view)
Target Audience (click to view)

This activity is designed to meet the needs of physicians.

Learning Objectives(click to view)

Upon completion of the educational activity, participants should be able to:

 

  • Review the link between rhinosinusitis and sleep quality.
  • Discuss the findings of a study that sought to determine the impact of comorbid obstructive sleep apnea on chronic rhinosinusitis disease-specific quality of life and sleep dysfunction in patients with chronic rhinosinusitis following functional endoscopic sinus surgery.

Method of Participation(click to view)

Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation.  A statement of credit will be available upon completion of an online evaluation/claimed credit form at www.akhcme.com/pwJuly01.  You must participate in the entire activity to receive credit.  If you have questions about this CME/CE activity, please contact AKH Inc. at dcotterman@akhcme.com.

Credit Available(click to view)

AKH

CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare

Physicians
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s.  AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.

 

AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Commercial Support(click to view)

There is no commercial support for this activity.

Disclosures(click to view)

It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.

Disclosure of Unlabeled Use & Investigational Product(click to view)

This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

 

Disclaimer(click to view)

This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.

Faculty & Credentials(click to view)

Keith D’Oria – Editorial Director
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

Timothy L. Smith, MD, MPH
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

AKH and PHYSICIAN WEEKLY’S STAFF/REVIEWERS

Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

AKH planners and reviewers have no relevant financial relationships to disclose.

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Timothy L. Smith, MD, MPH (click to view)

Timothy L. Smith, MD, MPH

Professor, Department of Otolaryngology-Head and Neck Surgery
Chief, Division of Rhinology and Sinus/Skull Base Surgery
Director, Oregon Sinus Center
Oregon Health & Science University

Timothy L. Smith, MD, MPH, has indicated to Physician’s Weekly that he has or has had no financial interests to report that are related to this research

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Patients with chronic rhinosinusitis appear to have a high prevalence of sleep dysfunction that improves after undergoing functional endoscopic sinus surgery, according to a study. Individuals with obstructive sleep apnea (OSA) should be treated concurrently for both chronic rhinosinusitis and OSA to optimize sleep dysfunction and improve quality of life.
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Research has shown that there are important links between quality of life (QOL), sleep quality, and chronic rhinosinusitis. Studies suggest that more than 75% of patients with chronic rhinosinusitis have abnormal sleep quality, with worse sleep often being experienced in patients with more severe chronic rhinosinusitis. Higher levels of sleep dysfunction can also impact treatment decisions for patients with chronic rhinosinusitis, with their choices ranging from undergoing surgical therapy or continuing medical management.

“Sleep disorders and fatigue are both common among patients with chronic rhinosinusitis,” says Timothy L. Smith, MD, MPH. “These comorbidities are thought to be, in part, related to chronic inflammation in the sinuses. In some cases, they may be the result of chronic infections. It has been suspected that blockages in the nasal passages are the primary reason for decreased sleep quality in patients with chronic sinusitis, and that sleep quality will improve after the airway obstruction is treated.”

Patients with chronic rhinosinusitis and comorbid obstructive sleep apnea (OSA) have a lower QOL than others, according to clinical investigations. “Both chronic rhinosinusitis and OSA are known to have substantial adverse effects on sleep,” says Dr. Smith.

 

Taking a Closer Look

There is evidence suggesting that functional endoscopic sinus surgery (FESS) can result in lasting improvements in chronic rhinosinusitis-specific QOL among patients with medically refractory disease. It is unclear, however, if similar improvements can be achieved in patients with chronic rhinosinusitis and comorbid OSA after FESS.

For a study published in JAMA Otolaryngology—Head & Neck Surgery, Dr. Smith and colleagues sought to determine the impact of comorbid OSA on chronic rhinosinusitis disease-specific QOL and sleep dysfunction in patients with chronic rhinosinusitis following FESS. The investigators conducted a prospective analysis involving 405 adults over a 3-year period at multiple sites.

The study group used the Rhinosinusitis Disability Index (RSDI) survey, the 22-item Sinonasal Outcome Test (SNOT-22), and the Pittsburgh Sleep Quality Index (PSQI) to measure preoperative and postoperative outcomes, using OSA as the primary, independent risk factor. According to the results, 15% of participants had comorbid OSA, a prevalence that resembles that of the general United States population. Significant postoperative improvements after FESS were reported across all disease-specific QOL measures for participants with comorbid OSA and for those without the disease. Patients without OSA also reported greater improvements on sleep quality and had fewer sleep disturbances.

Participants without OSA reported significantly greater improvements in RSDI global scores, RSDI physical and functional subdomain scores, and SNOT-22 rhinologic symptom domain scores. The average postoperative scores significantly improved over time for all disease-specific QOL outcome measures in patients with only chronic rhinosinusitis and in those with chronic rhinosinusitis and OSA (Table). However, patients without OSA reported significant sleep quality score improvement from preoperative scores for the PSQI, but those with comorbid OSA did not report such improvements as measured by any aspect of the PSQI.

 

Analyzing the Implications

Considering the high prevalence of OSA and chronic rhinosinusitis as well as their detrimental effects on physical and neuropsychiatric function, Dr. Smith says understanding the contribution that OSA makes in chronic rhinosinusitis has important implications. OSA has been linked to many health consequences that are thought to result from sleep disruption, including depression, hypertension, congestive heart failure, arrhythmias, myocardial infarction, stroke, and death.

“Sinus surgery may lead to better improvements in QOL and sleep quality in patients with chronic rhinosinusitis by improving control of chronic inflammation rather than simply improving nasal obstructions,” Dr. Smith says. Findings of the study suggest that patients with chronic rhinosinusitis have a high prevalence of sleep dysfunction that significantly improves following FESS. In addition, people with OSA should be treated concurrently for both chronic rhinosinusitis and OSA to optimize sleep dysfunction and improve QOL.

 

Directing Future Research

According to Dr. Smith, more studies are needed to further elucidate the discordance and underlying mechanisms of sleep improvement between patients who have chronic rhinosinusitis with and without OSA using objective sleep measures. “Our study shows that sleep quality is diminished in patients with chronic rhinosinusitis with and without OSA, but the underlying etiology and pathophysiologic mechanism of this sleep dysfunction are still unknown,” he says.

Future investigations should also explore the connection between reducing nasal obstructions and objective measures of sleep function. “We don’t know enough about all of the health consequences that can emerge in patients with chronic rhinosinusitis and comorbid OSA,” says Dr. Smith. “This highlights the fact that more studies are needed to look into these associations.”

Readings & Resources (click to view)

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 Otolaryngol Head Neck Surg. 2015;141:873-881. Available at: http://archotol.jamanetwork.com/article.aspx?articleid=2436627.

Alt JA, Smith TL, Schlosser RJ, Mace JC, Soler ZM. Sleep and quality of life improvements after endoscopic sinus surgery in patients with chronic rhinosinusitis. Int Forum Allergy Rhinol. 2014;4:693-701.

Alt JA, Smith TL, Mace JC, Soler ZM. Sleep quality and disease severity in patients with chronic rhinosinusitis. Laryngoscope. 2013;123:2364-2370.

Smith TL, Litvack JR, Hwang PH, et al. Determinants of outcomes of sinus surgery: a multi-institutional prospective cohort study. Otolaryngol Head Neck Surg. 2010;142:55-63.

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