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

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OBJECTIVE: Assess the impact of obstructive sleep apnea (OSA) on chronic rhinosinusitis (CRS) severeity. STUDY DESIGN: Retrospective database review. SETTING: TriNetX US database. METHODS: TriNetX US Collaborative Network database was queried for cohorts of patients with OSA, CRS, and CRS with comorbid OSA (CRS-OSA). Data included demographics, CRS severity was assessed via rates of endoscopic sinus surgery (ESS), antibiotic, and oral steroid use. Propensity score matching was performed to account for differences in demographics and clinical variables. RESULTS: The query identified 1,818,879 patients with CRS, 481144 with OSA, and 93,153 CRS-OSA patients. OSA-CRS patients had higher rates of hypertension, diabetes mellitus, obesity, and asthma than either CRS or OSA populations (P < 0.0001). CRS-OSA patients demonstrated higher rates of ESS (odds ratio [OR]: 1.91, 1.82-2.02, P < 0.0001), antibiotic (OR: 1.90, 1.81-1.96, P < 0.001), and oral steroid use (OR: 2.23, 2.16-2.28, P < 0.001) compared to CRS-only patients. CRS-OSA patients not on continuous positive airway pressure had higher utilization of antibiotics (OR: 3.24, 2.82-3.71, P < 0.0001) and steroids (OR: 2.28, 2.05-2.55, P < 0.0001) than nonutilizers. CRS-OSA patients with sleep-related surgical interventions required fewer antibiotic courses (OR: 1.93, 1.62-2.28, P < 0.0001). CONCLUSION: CRS-OSA patients experience higher rates of comorbidities associated with both diseases than those with CRS or OSA alone. OSA was associated with an increased risk of ESS, antibiotic, and steroid use in patients with CRS. There appears to be a correlation with treatment of OSA and CRS outcomes, however, further studies are required.

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