Obstructive Sleep Apnea and Chronic Rhinosinusitis: Understanding the Impact of OSA on CRS Disease Burden?

Introduction: Both obstructive sleep apnea (OSA) and chronic rhinosinusitis (CRS) significantly impact patients’ quality of life, with known functional and emotional sequelae. Up to 20% of patients with CRS have comorbid OSA, and conversely, patients with OSA are at increased risk of developing CRS. While the exact relationship between these conditions is not yet fully established, current literature hypothesizes that chronic, intermittent hypoxia from OSA creates a local, endonasal, and systemic inflammatory cascade which induces endothelial dysfunction seen in CRS. The purpose of this study was to investigate the effect of co-morbid OSA disease and treatment on CRS severity and outcomes.

Methods: TriNetX US Collaborative Network database inquiries were used to obtain cohorts of patients with a diagnosis of OSA, CRS, and both CRS-OSA. Data collected included demographic differences among the three cohorts, the severity of CRS as related to OSA status and antibiotic and steroid use between CRS-only and CRS-OSA patients. Demographic and clinical variables were used to create balanced cohorts via propensity matching.

Results: The query identified 1,818,879 TriNetX patients with CRS alone, 481,144 with OSA alone, and 93,271 CRS-OSA patients. 45% of this population was male compared with 52% of OSA patients (p < 0.0001). OSA-CRS patients had higher rates of HTN, DM, obesity, and asthma than either CRS or OSA populations alone (p < 0.0001). After propensity score matching, the combined CRS-OSA cohort demonstrated higher rates of antibiotic (OR: 1.59 p < 0.0001) and oral steroid use (OR: 1.33, p < 0.0001) compared with the CRS-only population. Treatment of patients’ OSA affected CRS disease burden. OSA-CRS patients that either did not use CPAP or had not pursued sleep surgery had higher rates of antibiotic (OR: 1.38, p < 0.0001) and steroid use (OR: 1.60, p < 0.0001) when compared OSA-CRS patients who did receive an intervention for their OSA despite similar rates of FESS surgery. CRS-OSA patients with a history of sleep-related surgical intervention required fewer steroid courses compared with untreated CRS-OSA patients (OR: 1.33, p < 0.0001). CPAP use alone did not affect CRS outcomes.

Conclusion: The presence of OSA increases the risk of CRS disease burden which is unaffected by CPAP use. CRS-OSA patients whose OSA was treated by surgical means demonstrated decreased rates of symptomatic CRS exacerbations as delineated by decreased steroid usage. These findings suggest that there may be benefit to surgically treating OSA in patients with refractory CRS.

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Artikel online veröffentlicht:
01. Februar 2023