uu.seUppsala University Publications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Incident Chronic Rhinosinusitis Is Associated With Impaired Sleep Quality: Results of the RHINE Study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
Karolinska Univ Hosp, Dept Clin Sci Intervent & Technol, Div Ear Nose & Throat Dis, Huddinge, Sweden.
Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Otorhinolaryngol Head & Neck Surg, Gothenburg, Sweden.
Show others and affiliations
2019 (English)In: Journal of Clinical Sleep Medicine (JCSM), ISSN 1550-9389, E-ISSN 1550-9397, Vol. 15, no 6, p. 899-905, article id PII jc-18-00575Article in journal (Refereed) Published
Abstract [en]

Study Objectives: Chronic rhinosinusitis (CRS) is a common inflammatory disease of the nasal cavity and paranasal sinuses. Associations between CRS and poor sleep quality have been reported. This 10-year follow-up study investigates possible associations between incident CRS and sleep quality. Methods: A questionnaire was sent to 16,500 individuals in Sweden, Norway, Denmark, Iceland and Estonia in 2000. It included questions on airway diseases, age, sex, body mass index, smoking habits, comorbidities, education and sleep quality. In 2010, a second questionnaire was sent to the same individuals, with a response rate of 53%. A subgroup of 5,145 individuals without nasal symptoms in 2000 was studied. Multiple logistic regression was performed to examine associations between CRS (defined according to the European position paper on rhinosinusitis and nasal polyps epidemiological criteria) at follow-up and sleep quality, with adjustment for potential confounders. Individuals with the respective sleep problem at baseline were excluded. Results: Over 10 years, 141 (2.7%) of the individuals without nasal symptoms in 2000 had developed CRS. CRS was associated with difficulties inducing sleep (adjusted odds ratio 2.81 [95% CI 1.67-4.70]), difficulties maintaining sleep (2.07 [1.35-3.18]), early morning awakening (3.03 [1.91-4.81]), insomnia (2.21 [1.46-3.35]), excessive daytime sleepiness (2.85 [1.79-4.55]), and snoring (3.31 [2.07-5.31]). Three insomnia symptoms at baseline increased the risk of CRS at follow-up by 5.00 (1.93-12.99). Conclusions: Incident CRS is associated with impaired sleep quality and excessive daytime sleepiness. Insomnia symptoms may be a risk factor for the development of CRS.

Place, publisher, year, edition, pages
AMER ACAD SLEEP MEDICINE , 2019. Vol. 15, no 6, p. 899-905, article id PII jc-18-00575
Keywords [en]
chronic rhinosinusitis, CRS, epidemiology, insomnia, sleep quality
National Category
Otorhinolaryngology
Identifiers
URN: urn:nbn:se:uu:diva-389988DOI: 10.5664/jcsm.7846ISI: 000471747600013PubMedID: 31138385OAI: oai:DiVA.org:uu-389988DiVA, id: diva2:1340168
Funder
Forte, Swedish Research Council for Health, Working Life and WelfareSwedish Heart Lung FoundationSwedish Asthma and Allergy AssociationAvailable from: 2019-08-02 Created: 2019-08-02 Last updated: 2019-12-19Bibliographically approved
In thesis
1. Nasal obstruction – impact on insomnia symptoms and sleep-disordered breathing
Open this publication in new window or tab >>Nasal obstruction – impact on insomnia symptoms and sleep-disordered breathing
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Nasal obstruction is very common in the general population, but the role of nasal obstruction in sleep quality is not clear. Nasal obstruction is also prevalent in patients with obstructive sleep apnoea (OSA) and may contribute to poor adherence to continuous positive airway pressure (CPAP) treatment.

Aims: To investigate the impact of subjective nasal obstruction, as a single symptom or as part of chronic rhinosinusitis (CRS), in both objective and subjective sleep quality, in three different population based cohorts. Another aim was to investigate the usefulness of the Sinonasal Outcome Test-22 (SNOT-22) and peak nasal inspiratory flow (PNIF) in the treatment of OSA patients.

Methods and results: In paper I (the SHE-study), a community-based sample of 400 women were investigated with polysomnography and questions on sleep quality, daytime- and nasal symptoms. Women with nasal obstruction at night (n=30) had significantly higher prevalence of several night time symptoms and excessive daytime sleepiness (EDS), but the polysomnography was normal.

In paper II (the GA2LEN study, n= 26, 647) and paper III (RHINE II and RHINE III studies, n= 5, 145) questionnaires on sleep quality, daytime- and nasal symptoms were used, and CRS was defined according to the epidemiological diagnostic criteria of the European Position Paper of Rhinosinusitis and Nasal Polyps (EPOS). In paper II, sleep problems were highly prevalent in CRS, and there was a dose-response relationship between the disease severity of CRS and sleep problems. The addition of persistent allergic rhinitis to CRS further increased the risk of sleep problems.

In paper III, 2.7% of individuals without nasal symptoms at baseline had developed CRS at follow-up 10 years later. Strong associations between incident CRS and impaired sleep quality and EDS were found. Three insomnia symptoms at baseline increased the risk for CRS at follow-up.

In paper IV, 197 OSA patients initiating CPAP treatment were investigated before starting CPAP and at the follow-up 3-4 weeks later. SNOT-22 scores were generally high among all OSA patients indicating a large sinonasal disease burden, and improved among those with CPAP adherence ≥ 4 hours/night. A low PNIF value increased the risk for poor CPAP adherence.

Conclusions: Subjective nasal obstruction at night impairs subjective sleep quality in women, but does not affect objective sleep quality. CRS impairs subjective sleep quality, and insomnia symptoms may be a risk factor for CRS. SNOT-22 and PNIF may be useful tools in the treatment of OSA patients.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2019. p. 95
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1604
Keywords
Chronic rhinosinusitis, CRS, nasal obstruction, sleep, sleep apnoea.
National Category
Otorhinolaryngology
Research subject
Oto-Rhino-Laryngology
Identifiers
urn:nbn:se:uu:diva-394085 (URN)978-91-513-0779-4 (ISBN)
Public defence
2019-11-29, Skoogsalen, ingång 78/79, 1 tr, Akademiska sjukhuset, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2019-11-07 Created: 2019-10-12 Last updated: 2019-11-27

Open Access in DiVA

No full text in DiVA

Other links

Publisher's full textPubMed

Authority records BETA

Bengtsson, CarolineJonsson, LarsJanson, ChristerLindberg, Eva

Search in DiVA

By author/editor
Bengtsson, CarolineJonsson, LarsJõgi, RainJanson, ChristerLindberg, Eva
By organisation
Otolaryngology and Head and Neck SurgeryDepartment of Medical SciencesLung- allergy- and sleep research
In the same journal
Journal of Clinical Sleep Medicine (JCSM)
Otorhinolaryngology

Search outside of DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 161 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf