Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.
Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Ann Allergy Asthma Immunol. 2017 Mar;118(3):286-289. doi: 10.1016/j.anai.2016.12.012.
Chronic rhinosinusitis (CRS) is associated with significant losses of patient productivity that cost billions of dollars every year. The causative factors for decreases in productivity in patients with CRS have yet to be determined.
To determine which patterns of CRS symptoms drive lost productivity.
Prospective, cross-sectional cohort study of 107 patients with CRS. Sinonasal symptom severity was measured using the 22-item Sinonasal Outcomes Test, from which sleep, nasal, otologic or facial pain, and emotional function subdomain scores were calculated using principal component analysis. Depression risk was assessed with the 2-item Patient Health Questionnaire (PHQ-2), whereas nasal obstruction was assessed with the Nasal Obstruction Symptom Evaluation (NOSE) instrument. Lost productivity was assessed by asking participants how many days of work and/or school they missed in the last 3 months because of CRS. Associations were sought between lost productivity and CRS symptoms.
A total of 107 patients were recruited. Patients missed a mean (SD) of 3.1 (12.9) days of work or school because of CRS. Lost productivity was most strongly associated with the emotional function subdomain (β = 7.48; 95% confidence interval [CI], 5.71-9.25; P < .001). Reinforcing this finding, lost productivity was associated with PHQ-2 score (β = 4.72; 95% CI, 2.62-6.83; P < .001). Lost productivity was less strongly associated with the nasal symptom subdomain score (β = 2.65; 95% CI, 0.77-4.52; P = .007), and there was no association between lost productivity and NOSE score (β = 0.01; 95% CI, -0.12 to 0.13; P = .91).
Symptoms associated with depression are most strongly associated with missed days of work or school because of CRS. Further treatment focusing on depression-associated symptoms in patients with CRS may reduce losses in productivity.
慢性鼻-鼻窦炎（CRS）与患者生产力的显著损失有关，每年造成数十亿美元的损失。导致 CRS 患者生产力下降的因素尚未确定。
确定哪些 CRS 症状模式导致生产力下降。
对 107 例 CRS 患者进行前瞻性、横断面队列研究。使用 22 项鼻-鼻窦结局测试（Sinonasal Outcomes Test）测量鼻-鼻窦症状严重程度，使用主成分分析计算出睡眠、鼻腔、耳痛或面部疼痛和情绪功能子域评分。使用 2 项患者健康问卷（PHQ-2）评估抑郁风险，使用鼻腔阻塞症状评估量表（NOSE）评估鼻腔阻塞。通过询问参与者在过去 3 个月内因 CRS 而错过多少个工作日和/或学校来评估生产力损失。寻找 CRS 症状与生产力损失之间的关联。
共招募了 107 例患者。患者因 CRS 而平均（SD）缺勤 3.1（12.9）个工作日或学校。生产力损失与情绪功能子域的相关性最强（β=7.48；95%置信区间 [CI]，5.71-9.25；P<.001）。这一发现得到了证实，生产力损失与 PHQ-2 评分相关（β=4.72；95% CI，2.62-6.83；P<.001）。生产力损失与鼻腔症状子域评分的相关性较弱（β=2.65；95% CI，0.77-4.52；P=0.007），生产力损失与 NOSE 评分之间没有关联（β=0.01；95% CI，-0.12 至 0.13；P=0.91）。
与抑郁相关的症状与因 CRS 而错过的工作日或学校天数最相关。在 CRS 患者中进一步针对与抑郁相关的症状进行治疗可能会减少生产力损失。
