The Role of Sleep Apnea in Chronic Sinusitis
One condition that may be associated with chronic sinusitis, which is often missed, is sleep apnea. Sometimes patients may have a syndrome know as CORE (Chronic Cough/Asthma, Obstructive Sleep Apnea, Rhinosinusitis and Esophageal Reflux) syndrome.
Over the years we have come to recognize the contribution of obstructive sleep apnea (OSA) to chronic sinusitis and, once addressed, many of the patient’s symptoms are much easier to manage.
The major way OSA contributes to chronic sinusitis is to worsen a patient’s reflux by pulling the gastric contents back into the throat, lungs and sinuses during the apneic event. In association is the fact that the highest concentrations of gastric acid occur between 10 PM to 2 AM, therefore it is easy to see how significant damage can be done to these mucosal layers on a nightly basis.
Another way in which OSA has a negative impact on CRS is by affecting the immune system. It is well-known that poor sleep will affect the immune system in numerous ways. Of course, these impacts vary with individuals.
Initially, my interest in sleep happened during my fellowship in infectious disease because back in the early nineties, we were seeing many patients for the diagnosis of Chronic Fatigue Syndrome (CFS).
My belief is that many cases of CFS are multi-factorial with sleep disturbances as a cornerstone of the syndrome. In many instances, patients diagnosed with CFS were found to have sleep apnea. This early work allowed me to become board certified in Sleep Medicine in 2011.
Sleep apnea, however, contributes too many other illnesses besides CRS and fatigue. Sleep apnea has been linked to cardiovascular disease in general by affecting several different metabolic pathways.
Sleep apnea has been found to worsen diabetes by increasing insulin resistance. Recently I had two obese patients with known OSA and diabetes that continually had to take more insulin to control their diabetes. The downside was that both patients were gaining weight despite dieting. Once their OSA was treated more aggressively with new CPAP settings their insulin requirements actually went down.
OSA has also been associated with metabolic syndrome, hypercholesterolemia and hypertension. Many of these can be managed with diet, lifestyle changes and medications, but when OSA is a contributing factor, management is much more difficult. Again the above-mentioned conditions are all known to contribute to cardiovascular disease.
Another way that OSA can affect the heart, is by causing heart arrhythmias. The most common arrhythmia associated with OSA is atrial fibrillation commonly known as A-fib. Patients with A-fib are at higher risk of having strokes than patients without A-fib. This is near and dear to my heart because my eighty-one-year-old mother has OSA and A-fib.
Unfortunately, the incidence of OSA continues to rise as the obesity epidemic worsens. It’s pretty obvious to see how obesity contributes to OSA with fat accumulation in the neck and oropharyngeal area which creates obstruction of the airway. This then begins the wormhole effect because untreated OSA also has a negative impact on weight loss, so even if the patient wants to lose weight, it is very difficult due to OSA effecting gherlin and leptin function.
Leptin is a hormone that is associated with lean muscle mass production and ghrelin is associated with appetite stimulation, especially for salty and sugary foods. Both hormones are increased with OSA. Unfortunately, OSA also contributes toleptin resistance and, though levels are higher, they are less effective when OSA is present.
OSA can affect humans negatively in many different ways, especially in the area of cardiovascular disease. If you or a loved-one are suspected of having OSA or if weight loss, hypertension, high cholesterol are not responding to therapy, please get evaluated for sleep apnea.
