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1.  Chronic Rhinosinusitis and Sleep: A Contemporary Review 
International forum of allergy & rhinology  2013;3(11):10.1002/alr.21217.
Patients with chronic rhinosinusitis (CRS) exhibit centrally mediated behavioral changes commonly referred to as sickness behavior. Sleep alteration is a component of sickness behavior which is estimated to affect up to 70 million patients annually. Patients with CRS have poor sleep quality, and little is known about the underlying etiology and pathophysiology. This narrative review aims to further organize and present the current knowledge associating sleep and CRS.
A literature search was conducted of the OVID MEDLINE database using key search words including: “chronic rhinosinusitis”, “sleep”, “sleep disorders”, and “sleep dysfunction”. Additional keywords “nasal obstruction”, “nasal polyp”, and “fatigue” were identified and utilized to further delineate relevant articles.
The articles that specifically addressed sleep and CRS were dissected and presented as follows; 1) chronic rhinosinusitis and sleep, 2) chronic rhinosinusitis and fatigue 3) chronic rhinosinusitis, nasal obstruction and sleep, 4) pathophysiology of sleep in chronic rhinosinusitis (cytokines in both sleep and chronic rhinosinusitis and their association to the neuroimmune biology of chronic rhinosinusitis).
Patients with CRS have sleep dysfunction that is associated with their disease severity and overall quality of life. The etiology of sleep dysfunction in CRS is most likely multifactorial. Increasing evidence suggests sleep dysfunction in patients with CRS is partly due to the inflammatory disease process, and sleep physiology in patients with CRS may be actively regulated by the inflammatory component of the disease.
PMCID: PMC3833888  PMID: 24039230
Sinusitis; sleep; fatigue; rhinology; review
2.  Sleep Quality and Disease Severity in Patients with Chronic Rhinosinusitis 
The Laryngoscope  2013;123(10):2364-2370.
To evaluate sleep quality in patients with chronic rhinosinusitis (CRS) using a validated outcome measure and compare measures of CRS disease severity with sleep dysfunction.
Study Design
Cross-sectional evaluation of a multi-center cohort
Patients with CRS according to the 2007 Adult Sinusitis Guidelines were prospectively enrolled from four academic, tertiary care centers across North America. Each subject completed the Pittsburgh Sleep Quality Index (PSQI) instrument, in addition to CRS-specific measures of quality-of-life (QOL), endoscopy, computed tomography (CT), and olfaction. Patient demographics, comorbid conditions, and clinical measures of disease severity were compared between patients with “good” (PSQI; ≤ 5) and “poor” (PSQI; >5) sleep quality.
Patients (n=268) reported a mean PSQI score of 9.4(range: 0–21). 75.0% of patients reported PSQI scores above the traditional cut-off indicating poor sleep quality. Patients with poor sleep quality were found to have significantly worse QOL scores on both the Rhinosinusitis Disability Index (p<0.001) and 22-item Sinonasal Outcome Test (p<0.001). No significant differences in average endoscopy, CT, or olfactory function scores were found between patients with good or poor sleep quality. Tobacco smokers reported worse average PSQI total scores compared to non-smokers(p=0.030). Patients reporting poor sleep were more likely to have a history of depression, even after controlling for gender (p=0.020).
The majority of patients with CRS have a poor quality of sleep as measured by the PSQI survey. Poor sleep quality is significantly associated with CRS-specific QOL, gender, comorbid depression, and tobacco use but not CT score or endoscopy grade.
PMCID: PMC3740761  PMID: 23918740
Sinusitis; chronic disease; sleep; quality of life; rhinitis; cross-sectional studies
3.  Differential expression of innate immunity genes in chronic rhinosinusitis 
Prior research has identified several components of the innate immune system that may play a significant role in chronic rhinosinusitis (CRS), but the role of innate immunity in patients with CRS is poorly understood. The objective of this study was to determine differential expression of innate immunity genes in the mucosa of patients with CRS with nasal polyposis (CRSwNP) and CRS without nasal polyposis (CRSsNP) when compared with controls.
Control patients (n = 9) and patients with CRS (n = 36) who failed medical management were prospectively enrolled. Ethmoid mucosa samples were harvested during surgery and quantitative real-time polymerase chain reaction was used to determine levels of mRNA expression of Toll-like receptor (TLR) 2 and TLR9 and interleukin-22 receptor (IL-22R). The average change in crossover threshold and fold change were calculated and differences between controls, CRSwNP, and CRSsNP were compared. Statistical analysis was performed using the Kruskall–Wallis and adjusted Mann–Whitney U tests.
Patients with CRSwNP (n = 16) and CRSsNP (n = 20) showed lower mean expression of TLR2 (p < 0.05) compared with controls. Patients with CRSsNP showed significantly higher mean expression of IL-22R (p < 0.05) than controls.
The sinonasal innate immune system may have a significant role in the development of CRS. We found differential expression of innate immune mediators between patients with and without nasal polyposis. These results provide further evidence of disruption of innate immunity at the mucosal level in CRS and highlight differences between polyp- and non–polyp-forming CRS phenotypes at the molecular level. In addition to our knowledge, this is the first report of altered IL-22R expression in CRSsNP patients. This study was a part of the clinical trial NCT01332136 registered in
PMCID: PMC4151703  PMID: 25198021
Chronic rhinosinusitis; chronic rhinosinusitis with nasal polyposis; IL-22R; innate immunity; TLR2; TLR9; Toll-like receptors
4.  Locally destructive skull base lesion: IgG4-related sclerosing disease 
Allergy & Rhinology  2012;3(1):e41-e45.
A unique case of IgG4+ sclerosing disease was diagnosed in the sphenoid sinus, a previously unreported location, and was treated in a novel manner. This study describes the clinical presentation and management of IgG4 sclerosing disease in the paranasal sinuses. A retrospective case review and review of the medical literature were performed. A 38-year-old woman with a 2-year history of constant frontal headaches presented to our clinic. Imaging showed bony destruction of the sphenoid sinus and sellar floor. The patient underwent a right-sided sphenoidotomy with debridement and biopsy. Pathological evaluation showed a dense plasmacytic infiltrate with >150 IgG4+ cells/high-power field. She was subsequently started on a nasal corticosteroid with improved patency of the sphenoid antrostomy. We report an unusual case of a middle-aged woman who presented with IgG4-sclerosing disease (IGSD) isolated to the sphenoid sinus. Although our knowledge concerning treatment in extrapancreatic organs is lacking, there is evidence that glucocorticoid treatment improves nasal sinus opacification on CT findings (Sato Y, Ohshima K, Ichimura K, et al., Ocular adnexal IgG4-related disease has uniform clinicopathology, Pathol Int 58:465–470, 2008). This case study and literature review adds to the growing literature describing IGSD in the head and neck and more specifically isolated to the sphenoid sinus with preliminary data concerning local control with topical steroids.
PMCID: PMC3404477  PMID: 22852129
Corticosteroid; IgG4; IGSD; sclerosing disease; skull base; sphenoid; sphenoidectomy

Results 1-4 (4)