By David Douglas
NEW YORK (Reuters Health) - 15/7/2019
A study of men with chronic rhinosinusitis with nasal polyps (CRSwNP) and obstructive sleep apnea (OSA) shows that symptoms may be less pronounced than in those with classic OSA, according to Brazilian researchers.
"Anthropometric characteristics in individuals with apnea caused by CRSwNP were significantly different from those in individuals with typical OSA," Dr. Debora Petrungaro Migueis told Reuters Health by email.
As reported June 15 online in Sleep Medicine, Dr. Migueis of the Federal University of the State of Rio de Janeiro and colleagues studied 31 patients with OSA alone and a further 62 with CRSwNP and OSA. All were men, because they are "more likely to have breathing-related sleep disorders than women and gender is known to affect CRS symptomatology," the researchers wrote.
Both groups underwent evaluation using the Epworth Sleepiness Scale (ESS) and overnight polysomnography as well as comparison of characteristics such as snoring, tiredness, high blood pressure and body mass index. Their OSA risk was also evaluated using the STOP-Bang questionnaire.
"Interestingly," said Dr. Migueis, "the median ESS showed low somnolence and a low median apnea-hypopnea index in patients with CRSwNP, although the lowest median oxygen saturation was not significantly different between groups."
Compared to those with OSA alone, in the CRSwNP group the incidence of fatigue was 73% less and somnolence was 63% less. For unrefreshing sleep, the incidence was 82% less. There were also 43% fewer complaints about snoring despite nasal obstruction being six times higher in the CRSwNP group. Their abdominal circumference was also lower. Less than 20% were obese, and their BMI ranged from 15.0 to 39.2, whereas in the polyp-free group, BMI ranged from 21.5 to 55.8.
Recognized these differences, the investigators conclude, "will improve screening and treatment of apneic patients (with) CRSwNP."
Dr. Susan Redline, Peter C. Farrell Professor of Sleep Medicine at Harvard Medical School, Boston, told Reuters Health by email, "The study, while small, suggests that patients with nasal polyps who have obstructive sleep apnea may not present with the typical features of sleep apnea recognized from studies of sleep clinic populations or from the general population."
Dr. Redline concluded, "While it is possible that people with nasal inflammation or obstruction may present a unique subtype of sleep apnea, further research is needed."
Sleep Med 2019.