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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...

Overnight Admissions After Younger Pediatric Tonsillectomy

In 1996, the American Academy of Pediatrics and the American Academy of Otolaryngology—Head and Neck Surgery (AAOHNS) released guidelines indicating that children younger than 3 be admitted overnight for postoperative observation. Studies had shown that young patients were at greater risk for postoperative complications that required readmission and inpatient care. Newer surgical techniques for tonsillectomy have helped to decrease the incidence of primary hemorrhage and shorten recovery time. More recent studies looking at complications with tonsillectomy in the very young—in addition to institutional and personal experiences in the operative setting—have caused some clinicians to question the need for overnight admission in these patients. In our experience, many patients who were electively admitted overnight met all of the criteria to be discharged home within 6 hours of their surgery.  A New Retrospective Review of Tonsillectomy More data are needed to establish an evidence-based justification for challenging the longstanding guidelines from AAOHNS. In the March 19, 2012 Archives of Otolaryngology—Head & Neck Surgery, my colleagues and I had a study published in which we retrospectively examined the outcomes of tonsillectomy performed in children under the age of 3. We recorded the complications they experienced. Among the 86 patients whose medical records were reviewed, 80 (93.0%) did not experience any intraoperative or postoperative complications. Complications after tonsillectomies were generally mild and typically linked to dehydration. Our study’s overall complication rate was beneath the 10% ceiling that has been deemed acceptable for ambulatory procedures by some in the field. Results from another study have reinforced our findings. Key Contributors for Success in Young Children Several factors likely contributed to the low rate of...

Managing Common Diabetes Comorbidities: Going Beyond Standard Care

This Physician’s Weekly feature covering the management of common diabetes comorbidities was completed in cooperation with the experts at the American Diabetes Association. Throughout the medical literature, it has been well documented that patients with type 2 diabetes are at increased risk for developing cardiovascular disorders, including coronary artery disease and stroke. The constellation of symptoms that includes insulin resistance and obesity greatly increases the likelihood of additional comorbidities emerging. “In addition to the commonly appreciated comorbidities of obesity, hypertension, and dyslipidemia,” says Medha N. Munshi, MD, “diabetes is also associated with other diseases or conditions at rates higher than those of people without diabetes.” In keeping with patient-centered approaches to care, physicians should be aware of the wide spectrum of comorbidities their patients face when managing them throughout their disease course. When the risk for these comorbidities is elevated, patients should be treated accordingly. The American Diabetes Association reports that some of the more common comorbidities outside the realm of obesity, hypertension, and dyslipidemia include obstructive sleep apnea (OSA), fatty liver disease, cancer, and fractures (Table 1). “Clinicians should consider these other comorbidities during their care of patients with diabetes to optimize outcomes,” says Dr. Munshi. Obstructive Sleep Apnea OSA is the most common form of sleep-disordered breathing in patients with type 2 diabetes, accounting for over 80% of cases. In people with diabetes, the prevalence of OSA has been documented to be as high as 23% and the prevalence of some form of sleep disordered breathing may be as high as 58%. “Treating sleep apnea can significantly improve quality of life and blood pressure control,” Dr. Munshi...
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