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The effect of intranasal corticosteroid on sleep instability and inflammatory profile of patients with sleep-disordered breathing and nasal polyps: A longitudinal study


The role of chronic rhinosinusitis with nasal polyps (CRSwNP) in sleep fragmentation still unclear. Sleep instability may be a consequence of upper airway flow limitation or nasal mucosa inflammation near the skull base. Cyclic alternating pattern (CAP) is a biological marker of sleep instability that can be useful in the evaluation of rhinosinusitis patients with sleep complaints.


This study aimed to evaluate the anti-inflammatory effect of intranasal corticosteroids on nasal obstruction, sleep fragmentation, and systemic inflammatory biomarkers.


After 60 days of washout, thirty CRSwNP individuals with sleep-disordered breathing used intranasal budesonide 400 mcg daily for 30 days. Pre and post-treatment, they underwent nasal endoscopy, nasal resistance score (nasal obstruction symptom evaluation [NOSE] and visual analogue scale [VAS]), fatigue severity scale, Epworth sleepiness scale, T helper 2 (Th2) inflammation measurement (serum levels of eosinophils, interleukin [IL]-4, and IL-5), intermittent hypoxia impact (serum levels of IL-6 and tumor necrosis factor-alpha), and type 1 polysomnography to quantify the sleep fragmentation using the cyclic alternating pattern (CAP). CAP is a sensitive electroencephalogram analysis of the non-rapid eye movement (NREM) sleep described as a marker of sleep instability. It was scored according to the 2012 AASM manual and Terzano’s rules by skilled professionals blinded to the endoscopy results and the corticosteroid use.


Thirty patients (18 males) with a median age of 53.50 years and body mass index 27.56 kg/m2, showed sleep fragmentation in NREM. The A1 subtype was the most frequent CAP subtype in N3, whereas A3 was the most frequent in N1 and N2. The prevalence of eosinophilia was high in pre and post-treatment. Intranasal corticosteroids decreased the subjective nasal obstruction (VAS, P = 0.005; NOSE, P = 0.008) and IL-5 levels (P = 0.005), but had no significant impact on other biomarkers, nasal endoscopy results, fatigue and somnolence scales, respiratory events, and macro/microarchitecture of sleep.


The anti-inflammatory effects of intranasal corticosteroids decreased the nasal resistance and Th2 systemic inflammation without any changes in sleep fragmentation, respiratory events, and hypoxia inflammatory biomarkers, highlighting that the CRSwNP population was evaluated using CAP.


Intranasal Corticosteroid; Cyclic Alternating Pattern; Hypoxia; Nasal Polyps; Sleep-Disordered Breathing; Sleep Fragmentation.


Área Clínica


Debora Migueis, Maria Cecilia Lopes, Luiz Thuler, Isabelle Vasconcellos, Lucas Lemes, Maria Helena Araujo-Melo, Glenda Lacerda