Sleep Subdomain of the Sinonasal Outcome Test as a Potential Screening Tool for Sleep Apnea in Chronic Rhinosinusitis

Abstract

ObjectivesApproximately 20% of patients with chronic rhinosinusitis (CRS) have comorbid obstructive sleep apnea (OSA). Patients with undiagnosed OSA are at high risk for perioperative complications. The Sinonasal Outcomes Test (SNOT‐22) Questionnaire is commonly administered to CRS patients, whereas OSA screening tools are less routinely employed. This study compared SNOT‐22 sleep subdomain (Sleep‐SNOT) scores among non‐OSA CRS versus OSA‐CRS patients undergoing ESS, and assessed sensitivity, specificity, and diagnostic accuracy of the Sleep‐SNOT for OSA screening.MethodsRetrospective review of patients that underwent endoscopic sinus surgery (ESS) for CRS from 2012 to 2021. Patients either carried a reported OSA diagnosis and completed the SNOT‐22, or had undocumented OSA status and completed both STOP‐BANG and SNOT‐22. Demographics, questionnaire scores, and OSA status were collected. A receiver operating characteristic (ROC) curve assessed cutoff scores, sensitivity, and specificity of the Sleep‐SNOT for OSA screening.ResultsOf 600 patients reviewed, 109 were included. 41% had comorbid OSA. OSA patients had a higher BMI (32.1 ± 7.7 vs. 28.35 ± 6.7 kg/m2; p = 0.02), Sleep‐SNOT (21.96 ± 12.1 vs. 16.8 ± 11.2; p = 0.021) and STOP‐BANG (3.1 ± 1.44 vs. 2.06 ± 1.27; p = 0.038) scores. A Sleep‐SNOT score of 17.5 had a sensitivity of 68.9%, specificity of 55.7%, and diagnostic accuracy of 63% for OSA detection (p = 0.022).ConclusionsSleep‐SNOT scores are greater for CRS‐OSA patients. The Sleep‐SNOT ROC curve demonstrates a high sensitivity, specificity, and accuracy for OSA screening in CRS patients. A Sleep‐SNOT score of ≥17.5 should prompt further OSA evaluation. The Sleep‐SNOT may be considered as a surrogate OSA screening tool when other validated tools are not employed.Level of EvidenceRetrospective chart review, Level 3 Laryngoscope, 133:2029–2034, 2023