. Author manuscript; available in PMC: 2024 Jan 1.

Published in final edited form as: Int Forum Allergy Rhinol. 2023 Mar 30;13(7):1061–1482. doi: 10.1002/alr.23079

TABLE VII.G. 3.

Association of chronic rhinosinusitis and OSA

Study	Year	LOE	Study design	Study groups	Clinical endpoints	Conclusions
Quinn et al.⁹¹⁶	2017	2a	Meta-analysis	6 prospective cohort studies; two retrospective case series	Relationship between sleep-disordered breathing and CRS.	Sleep quality is compromised in CRS patients with significant improvement in subjective sleep quality after medical and surgical treatment. Data is limited regarding objective measures of sleep following treatment for CRS.
Alt et al.⁹¹⁵	2019	2b	Case–control study	52 patients with CRS and 56 controls	Objective sleep measures in CRS patients assessed by home polysomnogram.	Patients with CRS were found to have an increased number of awakenings (p = 0.004), lower average overnight oxygen saturation (p = 0.042), increased REM latency (p = 0.016), and increased snoring at >40 dB (p = 0.034).
Alt et al.⁹¹⁴	2015	2b	Prospective cohort study	405 patients undergoing endoscopic sinus surgery for medically refractory chronic rhinosinusitis without nasal polyposis	Impact of comorbid OSA on sleep dysfunction in patients with CRS following functional endoscopic sinus surgery as assessed by Pittsburgh Sleep Quality Index (PSQI).	15% of CRS patients had comorbid OSA and had substantial disease-specific QOL improvements following endoscopic sinus surgery (p < 0.05).
Rotenberg et al.⁹¹⁹	2015	2b	Prospective cohort study	53 patients undergoing endoscopic sinus surgery for medically refractory chronic rhinosinusitis without nasal polyposis	Sleep quality following sinus surgery recorded at baseline and 6 months after surgery assessed with Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI).	Sinus surgery for CRS is associated with improved patient-reported sleep quality (p < 0.01).
Tosun et al.⁹²⁰	2009	2b	Prospective cohort study	27 patients with nasal polyposis underwent endoscopic sinus surgery with polypectomy	Effect of endoscopic sinus surgery on sleep quality in patients with chronic nasal obstruction resulting from nasal polyposis evaluated by questionnaire and polysomnography before and 3 months after the surgery.	While endoscopic sinus surgery with polypectomy significantly improved snoring and daytime sleepiness in patients with chronic nasal obstruction due to nasal polyposis (p < 0.01), it did not demonstrate a significant change in AHI (p = 0.55).
Yalaman-chali et al.⁹²¹	2014	2c	Retrospective cohort study	56 patients with OSA and chronic rhinosinusitis who underwent septoplasty with bilateral submucosal inferior turbinate reduction and concurrent endoscopic sinus surgery	Impact of combined nasal surgery and endoscopic sinus surgery on OSA assessed by polysomnography before and 3 months after the surgery.	AHI improved significantly after combined nasal surgery and endoscopic sinus surgery in patients with moderate OSA (p = 0.023) and severe OSA (p = 0.034), while patients with mild OSA did not have significant changes in AHI.
Sunderram et al.⁹¹⁷	2019	2b	Cross sectional study	601 subjects enrolled in the WTC Health Program underwent two nights of home sleep testing	Association between CRS and OSA.	CRS is an independent risk factor for OSA (odds ratio of 1.80; p 5.006), even after adjusting for age, BMI, sex, GERD, and EtOH use.
Jiang et al.⁹¹⁸	2016	2b	Cross sectional study	139 CRS patients who underwent functional endoscopic sinus surgery	Impact of CRS on sleep-disordered breathing as assessed by PSG and ESS.	OSA was diagnosed in 64.7% of patients with CRS, but there was no correlation with the severity of rhinosinusitis. The study did not assess for change in PSG or ESS outcomes after treatment.
Alt et al.⁹²²	2014	2b	Cross sectional study	20 CRS subjects completed disease-specific QOL and olfactory instruments	Association between immune mediators that have been associated with CRS and sleep-disordered breathing as assessed by Pittsburgh Sleep Quality Index (PSQI).	Increased expression of TGF-β (r = −0.443; p = 0.050) and IL-4 (r = −0.548; p = 0.012) correlated with sleep dysfunction, whereas IL-13 expression was linearly associated with worse sleep quality (PSQI scores r = −0.417; p = 0.075).