THE SLEEP INSTABILITY IN CHRONIC RHINOSINUSITIS PATIENTS WITH NASAL POLYPS USING CAP ANALYSES DURING NREM SLEEP

Abstract Introduction The sleep instability can increase the impact of several sleep disorders. The chronic rhinosinusitis leads to sleep fragmentation, and changes in systemic inflammatory biomarkers followed by upper airway flow limitation or nasal mucosa inflammation near the skull base. To evaluate the effect of sleep dysruption in chronic rhinosinusitis patients with nasal polyps using CAP analyses, this study aimed to analyse these patients before and after the anti-inflammatory effect of intranasal corticosteroids on nasal obstruction. Methods After two months of washout, thirty individuals with nasal polyps and sleep-disordered breathing used intranasal budesonide 400 mcg every day for one month. Before and after the treatment, they underwent the same exams: nasal endoscopy, subjective nasal resistance scores, fatigue severity scale, and Epworth sleepiness scale. Besides, T helper-two inflammation was measured by serum levels of eosinophils, interleukin-four and five. Intermittent hypoxia impact was documented using serum levels of IL-6 and tumor necrosis factor-alpha. Type 1 polysomnography was performed. It was scored according to the last manual of AASM and Terzano’s rules. The nonparametric Wilcoxon test was used to assess within-group differences before and after exposure to corticosteroids. Correlation between quantitative variables was analyzed by using the Spearman correlation coeficient, and p< 0.05 was statistically significant. Results All the participants had sleep' fragmentation in non-REM sleep. The treatment decreased the subjective nasal obstruction (p<0.005) and IL-5 levels (p<0.05), without significant impact on other biomarkers, nasal endoscopy results, fatigue or somnolence scales, and sleep architecture. Interestingly, the subtypes of phase A of CAP weren′t statistically significant (p>0.05) decreased compared two groups (before and after treatment). Conclusion The anti-inflammatory effects of intranasal corticosteroid decreased the nasal resistance and Th2 systemic inflammation without any changes in sleep fragmentation, highlighting. Terzano’s manual quantifies the sleep fragmentation using the cyclic alternating pattern, and it can be a sensitive electroencephalogram analysis of the non-NREM sleep described as a marker of sleep instability, however the analyse of phase A subtypes CAP did not show changes sleep disruption in patients with nasal polyps after their treatment of nasal mucosa inflammation. More studies are need to clarify the sleep complaints in these patients. Support (If Any)