慢性鼻-鼻窦炎患者内镜鼻窦手术后睡眠及生活质量的改善
Sleep and quality of life improvements after endoscopic sinus surgery in patients with chronic rhinosinusitis.
作者信息
Alt Jeremiah A, Smith Timothy L, Schlosser Rodney J, Mace Jess C, Soler Zachary M
机构信息
Division of Head and Neck Surgery, Rhinology-Sinus and Skull Base Surgery Program, Department of Surgery; University of Utah, Salt Lake City, UT.
出版信息
Int Forum Allergy Rhinol. 2014 Sep;4(9):693-701. doi: 10.1002/alr.21364. Epub 2014 Jul 30.
BACKGROUND
Recent investigation has demonstrated that approximately 75% of patients with medically refractory chronic rhinosinusitis (CRS) report abnormal sleep quality, with strong correlation between worse sleep quality and more severe CRS disease severity. It remains unknown whether the treatment effect of endoscopic sinus surgery (ESS) for CRS results in appreciable sleep quality improvements.
METHODS
Adult patients (aged ≥18 years) with a current diagnosis of recalcitrant chronic rhinosinusitis (CRS), who voluntarily elected ESS as the next treatment modality (n = 301), were prospectively evaluated within 4 academic, tertiary care centers using treatment outcome instruments: the Rhinosinusitis Disability Index, the 22-item Sinonasal Outcome Test, the 2-item Patient Health Questionnaire, and the Pittsburgh Sleep Quality Index (PSQI) both before and after ESS.
RESULTS
Seventy-two percent (72%) of patients with CRS were found to have poor sleep (PSQI > 5) at baseline with a mean (standard deviation) global PSQI score of 9.4 (4.6). Surgery improved overall mean global PSQI scores (by 2.2 points), and all 7 subdomain scores of the PSQI. Similarly, the odds of good sleep quality (PSQI ≤ 5) in patients treated with sinus surgery increased significantly (odds ratio [OR] 5.94; 95% confidence interval [CI], 3.06 to 11.53; p < 0.001). Stepwise multivariate linear regression found that acetylsalicylic acid (ASA) intolerance (β [standard error], -1.94 [0.93]; 95% CI, -3.77 to -0.11; p = 0.038), history of prior sinus surgery (β [standard error], 1.10 (0.54); 95% CI, 0.03 to 2.16; p = 0.044), and frontal sinusotomy (β [standard error], -1.03 [0.62]; 95% CI, -2.26 to 0.20; p = 0.099) were found to significantly associate with improvement in PSQI sleep scores.
CONCLUSION
Among patients with CRS, reduced sleep quality, poor disease-specific quality of life, and greater disease severity were improved following ESS.
背景
最近的调查表明，约75%药物治疗无效的慢性鼻窦炎（CRS）患者报告睡眠质量异常，睡眠质量越差与CRS疾病严重程度越高之间存在强烈相关性。ESS治疗CRS的效果是否能显著改善睡眠质量仍不清楚。
方法
在4个学术性三级医疗中心，对目前诊断为顽固性慢性鼻窦炎（CRS）且自愿选择ESS作为下一步治疗方式的成年患者（年龄≥18岁，n = 301），使用治疗结果评估工具进行前瞻性评估：鼻窦炎残疾指数、22项鼻鼻窦结局测试、2项患者健康问卷以及ESS前后的匹兹堡睡眠质量指数（PSQI）。
结果
发现72%的CRS患者基线时睡眠质量差（PSQI > 5），PSQI总体平均得分（标准差）为9.4（4.6）。手术改善了PSQI总体平均得分（提高2.2分）以及PSQI的所有7个亚领域得分。同样，接受鼻窦手术患者睡眠质量良好（PSQI≤5）的几率显著增加（优势比[OR] 5.94；95%置信区间[CI]，3.06至11.53；p < 0.001）。逐步多元线性回归发现，阿司匹林（ASA）不耐受（β[标准误]，-1.94 [0.93]；95% CI，-3.77至-0.11；p = 0.038）、既往鼻窦手术史（β[标准误]，1.10 (0.54)；95% CI，0.03至2.16；p = 0.044）以及额窦切开术（β[标准误]，-1.03 [0.62]；95% CI，-2.26至0.20；p = 0.099）与PSQI睡眠得分改善显著相关。
结论
在CRS患者中，ESS后睡眠质量下降、疾病特异性生活质量差以及疾病严重程度增加的情况均得到改善。
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