Sleep dysfunction in aspirin exacerbated respiratory disease: A prospective cohort study

Objective: Studies have described sleep dysfunction (SD) in patients with chronic rhinosinusitis (CRS). However, there is a paucity of literature describing sleep dysfunction in the context of aspirin-exacerbated respiratory disease (AERD). The purpose of this study was to evaluate the prevalence and severity of SD in patients with AERD relative to CRS. Methods: This study is a prospective cohort study. Patients diagnosed with CRS without polyposis (CRSsNP, n = 206), CRS with nasal polyposis (CRSwNP, n = 38), and AERD (n = 28) were recruited prospectively in academic center rhinology clinic. SD was assessed using the Neuro-QOL Short Form v1.0-Sleep Disturbance (sleep-QOL), for which severe SD is defined as a score >2.0 standard deviations from the normalized mean. Demographic and patient-reported outcome measures (including SNOT-22 and PHQ-2) were collected to adjust for sleep confounders. Comparisons were made between groups using univariate and multivariate analyses. Results: The prevalence of severe SD was significantly higher in AERD (57.1%) than in CRSsNP (32.5%) or CRSwNP (34.2%), p = 0.038. After adjusting for sleep confounders, the risk of sleep dysfunction remained higher among patients with AERD (odds ratio [OR] = 2.72 vs. CRSsNP, 95% confidence interval [CI] = 1.18-6.27, p = 0.02; OR = 3.06 vs. CRSwNP, 95% CI = 1.06-8.82, p = 0.04). SNOT-22 total score and the sleep subdomain showed no correlation with sleep-QOL score. Conclusions: The frequency and severity of SD are greater in AERD patients than in patients with CRS with or without nasal polyposis, independent of confounders of sleep quality. While the putative link between AERD and SD remains elusive, this study suggests that SD in AERD may be greater than previously recognized.