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SNOT-22 may help identify patients with undiagnosed OSA



Among patients who present with rhinologic symptoms, the 22-item Sinonasal Outcomes Test (SNOT-22) can help identify those with undiagnosed obstructive sleep apnea (OSA), results from a retrospective analysis demonstrated.

Dr. David W. Jang of Duke University, Durham, N.C.

Dr. David W. Jang

“We know based on experience and prior studies that there is significant overlap in symptoms for obstructive sleep apnea and chronic rhinosinusitis [CRS], which are two common conditions in the general population,” one of the study authors, David W. Jang, MD, said in an interview in advance of the Triological Society’s Combined Sections Meeting. “Therefore, it is important to identify patients with undiagnosed OSA who may present to the physician with nose- and sinus-related symptoms.”

Dr. Jang, assistant professor of rhinology and endoscopic skull surgery in the department of surgery at Duke University, Durham, N.C., and his colleagues conducted a 3-year retrospective analysis of 165 adults who presented with a rhinologic chief complaint and completed the SNOT-22 survey. The researchers compared SNOT-22 survey results between patients with untreated OSA confirmed on polysomnography without chronic rhinosinusitis and a control group of CRS patients. A chi-square test with Bonferroni correction was used for analysis.

Of the 165 patients, 41 met criteria for untreated OSA, based on a mean apnea-hypopnea index of 29.3, while 124 were included in the CRS control group. Sleep and psychological domain scores were not significantly different between the two groups, although patients in the OSA group were more likely to choose a sleep-related symptom as their most important complaint (MIC) (P less than .001). As for the cardinal symptoms of CRS, nasal discharge and loss of smell were significantly higher in the CRS group (P less than .001), while facial pain and nasal obstruction were not significantly different (P = .117 and P = .198, respectively). Facial pain and nasal obstruction were the most common MICs in the rhinologic domain for OSA patients; thick nasal discharge and postnasal discharge were the most common MICs reported by patients in the CRS group.

“It was surprising that, for the cardinal symptoms of CRS, only two of the four were significantly worse for the CRS group and predictive of CRS [nasal discharge and loss of smell],” Dr. Jang said. “Nasal obstruction and facial pain scores were similar between the two groups. Also, there was no significant difference in each of the sleep-related questions when comparing the CRS and OSA groups.”

He concluded that the findings further underscore the “significant overlap in symptoms between CRS and OSA. The SNOT-22 questionnaire may help identify patients with undiagnosed OSA.”

Dr. Jang acknowledged certain limitations of the study, including its retrospective design and relatively small sample size. He reported receiving research funding from Olympus.

The meeting was jointly sponsored by the Triological Society and the American College of Surgeons.

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