The impact of sinus surgery on sleep outcomes

Functional endoscopic sinus surgery (FESS) is standard for patients who fail medical management of chronic sinusitis (CRS). The beneficial impact of surgery on CRS is well known. However, patients often note that their sleep is improved after FESS even without simultaneous correction of nasal obstruction. Sleep outcomes after FESS are significantly understudied. Hence in the current study we look to characterize patient sleep quality following sinus surgery.

Data was gathered from 2 sites (Western University [Canada] and the Asia Sleep Center [Singapore]). Patients meeting diagnostic criteria for CRS without nasal polyposis (CRSsNP) were included. Cases with polyposis and those who needed a septoplasty were excluded so as to purely analyze the impact of the sinus surgery on sleep. Sleep outcomes recorded at baseline just prior to surgery and 6 months after surgery were the Epworth Sleepiness Scale (EpSS) and the Pittsburgh Sleep Quality Index (PSQI). We also recorded 22-item Sino-Nasal Outcome Test (SNOT-22) scores and Nasal Obstruction Symptom Evaluation (NOSE) scores. Comparisons were made with paired t tests.

Fifty-three patients met inclusion/exclusion criteria. Sleep outcomes showed a clinically and statistically significant improvement (EpSS before FESS = 14.7 ± 3.1, EpSS after FESS = 9.1 ± 1.1, p < 0.01; PSQI before FESS = 10.9 ± 2.8, PSQI after FESS = 5.3 ± 2.2, p < 0.01). CRS-specific outcomes were improved as well. Nasal obstruction scores did not change significantly.

FESS improved sleep outcomes for the patients in our study. This was independent of correction of nasal obstruction. Sinus surgery for CRSsNP has a beneficial impact on sleep; this novel information can be used during patient counseling and for justification to third-party payers.