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Endoscopic Sinus Surgery & Sleep Dysfunction

Endoscopic Sinus Surgery & Sleep Dysfunction

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...
Guidelines for Diagnosing OSA

Guidelines for Diagnosing OSA

Between 10% and 17% of Americans have moderate to severe sleep apnea, according to recent estimates. The prevalence of the condition has been increasing in recent years, due in part to the escalating obesity rate in the United States. However, an estimated 80% of those with sleep apnea remain undiagnosed. Addressing the Issue “Polysomnographs are considered the reference standard for an obstructive sleep apnea (OSA) diagnosis, but it requires specialized facilities,” explains Dr. Qaseem, lead author of the recent guidelines on OSA from the American College of Physicians (ACP). “Polysomnographs are also resource intensive and expensive and require patients to stay overnight for observation. As an alternative to polysomnographs, portable monitors are increasingly being used because they are much cheaper and more convenient for patients.” Portable monitors are broken down into types II through IV, with polysomnographs being designated as type I (Table 1). Two Recommendations The ACP recommends that a sleep study be performed for patients with unexplained daytime sleepiness. “This is a weak recommendation based on low-quality evidence,” Dr. Qaseem says, “but we believe that there is a need to have a targeted approach to diagnosing OSA. This starts with evaluation of the risk factors and common symptoms. Patients with daytime sleepiness have been shown to be the most responsive to OSA treatment, whereas there is a lack of evidence supporting treatment benefits to improve other outcomes, such as hypertension, diabetes, or coronary disease, especially in patients without daytime sleepiness.” To perform a sleep study in these patients, the ACP recommends polysomnographs for diagnostic testing. “If polysomnographs are available, they should be used,” adds Dr. Qaseem. “Portable...
Guidelines for Managing OSA in Adults

Guidelines for Managing OSA in Adults

Obstructive sleep apnea (OSA) is a common disorder that affects patients of all ages, especially those who are middle-aged and elderly. “Studies show that OSA rates are increasing in the United States, most likely because of rising obesity rates,” says Molly Cooke, MD. “Further complicating matters is that OSA is often misdiagnosed because its symptoms are not always specific to the disease.” In late 2013, the American College of Physicians (ACP) published guidelines in Annals of Internal Medicine that presented evidence and provided clinical recommendations on the management of OSA in adults. Using studies from 1966 to 2012, the ACP assessed several treatments that are designed to alleviate airway obstruction during sleep. “Our purpose was to present information on OSA interventions in order to determine the net benefits of these treatments,” says Dr. Cooke, who was on the ACP writing committee. She adds that the target audience for the guidelines includes all clinicians, and the target patient population comprises all adults with OSA. 3 Key Recommendations for Obstructive Sleep Apnea The ACP guidelines make three recommendations for treating OSA in adults (Table 1), and Dr. Cooke says the first line of defense should be weight loss. “Obesity is a risk factor for OSA,” she says. “All overweight and obese patients who have OSA should be encouraged to lose weight.” The evidence shows that some intensive weight-loss programs may effectively reduce signs and symptoms in obese patients with or without diabetes. Those signs and symptoms can include the apnea-hypopnea index (AHI), daytime sleepiness, and oxygen saturation. Weight loss is also associated with many health benefits other than for OSA. If...
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