2018 Section 5 - Rhinology and Allergic Disorders

Sukato et al

ethmoidectomy, sphenoidotomy, or frontal sinusotomy, with or without septoplasty, inferior turbinate reductions, and polypectomy as adjuncts. With imprecise follow-up times in the final data, our confidence in calculated effect sizes is also attenuated, as short- versus long-term changes are not clearly distinguished. These inherent variabilities are reflected in the high het- erogeneity parameter of the final data set. The I 2 statistics, a derivative of Cochran’s Q , is a percentage measure of var- iance that is attributable to study heterogeneity instead of chance. 38 Although the I 2 value is high among the studies in this review (95%-99%), this is partially addressed by a random effects meta-analysis, 53,54 which assumes that a dis- tribution of effect sizes exists, not a single mean common effect among studies. Moreover, the random effects model gives more relative weight to small studies (vs a fixed effects analysis) and has wider 95% CIs, consistent with the additional uncertainty that accompanies high heterogeneity. In summary, our meta-analysis provides insight into the effect of CRS-related endoscopic sinus surgery on sleep qual- ity. As an important contributing parameter to QOL and health, restful sleep is a priority among many patients, and an honest discussion regarding the effect of endoscopic sinus surgery on sleep disturbance is paramount in the clinical set- ting. Our results show a large and statistically significant effect of endoscopic sinus surgery on 2 validated sleep instruments— namely, the ESS and PSQI. Smaller improvements in AHI were found after CRS-related endoscopic sinus surgery, suggesting that nasal surgery may be a useful adjunct in controlling obstructive apneas in patients with concurrent CRS. Further studies are required to elucidate the effects on the sdSNOT-22 and sdRSDI, as a meta-analysis could not be performed on these outcome measures. Author Contributions Daniel C. Sukato , lead author, study design, data collection, data interpretation, final approval; Jason M. Abramowitz , contributing author, study design and conception, data collection, data interpre- tation, final approval; Marina Boruk , contributing author, data interpretation, manuscript editor, final approval; Nira A. Goldstein , contributing author, data interpretation, manuscript editor, final approval; Richard M. Rosenfeld , principal investigator, study design, statistical analysis, data interpretation, manuscript editor, final approval.

3. Alt JA, Smith TL, Mace JC, Soler ZM. Sleep quality and disease severity in patients with chronic rhinosinusitis. Laryngoscope . 2013;123:2364-2370. 4. Alt JA, Smith TL. Chronic rhinosinusitis and sleep: a contem- porary review. Int Forum Allergy Rhinol . 2013;3:941-949. 5. Cappuccio FP, Miller MA. Sleep and mortality: cause, conse- quence, or symptom? Sleep Med . 2013;14:587-588. 6. Azevedo Da Silva M, Singh-Manoux A, Shipley MJ, et al. Sleep duration and sleep disturbances partly explain the associ- ation between depressive symptoms and cardiovascular mortal- ity: the Whitehall II cohort study. J Sleep Res . 2014;23:94-97. 7. Wells ME, Vaughn BV. Poor sleep challenging the health of a nation. Neurodiagn J . 2012;52:233-249. 8. Alvarez GG, Ayas NT. The impact of daily sleep duration on health: a review of the literature. Prog Cardiovasc Nurs . 2004; 19:56-59. 9. DeConde AS, Mace JC, Bodner T, et al. SNOT-22 quality of life domains differentially predict treatment modality selection in chronic rhinosinusitis. Int Forum Allergy Rhinol . 2014;4:972-979. 10. Levy JM, Mace JC, Rudmik L, Soler ZM, Smith TL. Low 22- item sinonasal outcome test scores in chronic rhinosinusitis: why do patients seek treatment? Laryngoscope . 2017;127:22-28. 11. 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. 12. Alt JA, Smith TL, Schlosser RJ, Mace JC, Soler ZM. Sleep and quality of life improvements after endoscopic sinus sur- gery in patients with chronic rhinosinusitis. Int Forum Allergy Rhinol . 2014;4:693-701. 13. Rotenberg BW, Pang KP. The impact of sinus surgery on sleep outcomes. Int Forum Allergy Rhinol . 2015;5:329-332. 14. Tosun F, Kemikli K, Yetkin S, Ozgen F, Durmaz A, Gerek M. Impact of endoscopic sinus surgery on sleep quality in patients with chronic nasal obstruction due to nasal polyposis. J Craniofac Surg . 2009;20:446-449. 15. Gunhan K, Zeren F, Uz U, Gumus B, Unlu H. Impact of nasal polyposis on erectile dysfunction. Am J Rhinol Allergy . 2011; 25:112-115. 16. Yalamanchali S, Cipta S, Waxman J, Pott T, Joseph N, Friedman M. Effects of endoscopic sinus surgery and nasal surgery in patients with obstructive sleep apnea. Otolaryngol Head Neck Surg . 2014;151:171-175. 17. Benninger MS, Khalid AN, Benninger RM, Smith TL. Surgery for chronic rhinosinusitis may improve sleep and sexual func- tion. Laryngoscope . 2010;120:1696-1700. 18. Varendh M, Johannisson A, Hrubos-Strom H, Andersson M. Sleep quality improves with endoscopic sinus surgery in patients with chronic rhinosinusitis and nasal polyposis. Rhinology . 2017;55:45-52. 19. Browne JP, Hopkins C, Slack R, Cano SJ. The Sino-Nasal Outcome Test (SNOT): can we make it more clinically mean- ingful? Otolaryngol Head Neck Surg . 2007;136:736-741. 20. Alt JA, Ramakrishnan VR, Platt MP, et al. Sleep quality out- comes after medical and surgical management of chronic rhi- nosinusitis. Int Forum Allergy Rhinol . 2017;7:113-118.

Disclosures Competing interests: None. Sponsorships: None. Funding source: None.

References

1. Desrosiers M, Evans GA, Keith PK, et al. Canadian clinical practice guidelines for acute and chronic rhinosinusitis. J Otolaryngol Head Neck Surg . 2011;40(suppl 2):S99-S193. 2. Soler ZM, Wittenberg E, Schlosser RJ, Mace JC, Smith TL. Health state utility values in patients undergoing endoscopic sinus surgery. Laryngoscope . 2011;121:2672-2678.

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