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Volume 15 No. 06
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Accepted Papers

Scientific Investigations

Incident Chronic Rhinosinusitis Is Associated With Impaired Sleep Quality: Results of the RHINE Study

Caroline Bengtsson, MD1; Lars Jonsson, MD, PhD1; Mats Holmström, MD, PhD2; Johan Hellgren, MD, PhD3; Karl Franklin, MD, PhD4; Tórarinn Gíslason, MD, PhD5; Mathias Holm, MD, PhD6; Ane Johannessen, PhD7,8; Rain Jõgi, MD, PhD9; Vivi Schlünssen, MD, PhD10; Christer Janson, MD, PhD11; Eva Lindberg, MD, PhD11
1Department of Surgical Sciences, Otorhinolaryngology, Head and Neck Surgery, Uppsala University, Uppsala, Sweden; 2Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska University Hospital, Huddinge, Sweden; 3Department of Otorhinolaryngology, Head and Neck Surgery, Sahlgrenska Academy, Gothenburg, Institute of Clinical Science, University of Gothenburg, Sweden; 4Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden; 5Department of Respiratory Medicine and Sleep, University of Iceland, Reykjavik, Iceland; 6Department of Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden; 7Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway; 8Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway; 9Department of Pulmonology, Tartu University Hospital, Tartu, Estonia; 10Department of Public Health, Aarhus University, Aarhus, Denmark, National Research Centre for the Working Environment, Copenhagen, Denmark; 11Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden

Study Objectives:

Chronic rhinosinusitis (CRS) is a common inflammatory disease of the nasal cavity and paranasal sinuses. Associations between CRS and poor sleep quality have been reported. This 10-year follow-up study investigates possible associations between incident CRS and sleep quality.


A questionnaire was sent to 16,500 individuals in Sweden, Norway, Denmark, Iceland and Estonia in 2000. It included questions on airway diseases, age, sex, body mass index, smoking habits, comorbidities, education and sleep quality. In 2010, a second questionnaire was sent to the same individuals, with a response rate of 53%. A subgroup of 5,145 individuals without nasal symptoms in 2000 was studied. Multiple logistic regression was performed to examine associations between CRS (defined according to the European position paper on rhinosinusitis and nasal polyps epidemiological criteria) at follow-up and sleep quality, with adjustment for potential confounders. Individuals with the respective sleep problem at baseline were excluded.


Over 10 years, 141 (2.7%) of the individuals without nasal symptoms in 2000 had developed CRS. CRS was associated with difficulties inducing sleep (adjusted odds ratio 2.81 [95% CI 1.67–4.70]), difficulties maintaining sleep (2.07 [1.35–3.18]), early morning awakening (3.03 [1.91–4.81]), insomnia (2.21 [1.46–3.35]), excessive daytime sleepiness (2.85 [1.79–4.55]), and snoring (3.31 [2.07–5.31]). Three insomnia symptoms at baseline increased the risk of CRS at follow-up by 5.00 (1.93–12.99).


Incident CRS is associated with impaired sleep quality and excessive daytime sleepiness. Insomnia symptoms may be a risk factor for the development of CRS.


Bengtsson C, Jonsson L, Holmström M, Hellgren J, Franklin K, Gíslason T, Holm M, Johannessen A, Jõgi R, Schlünssen V, Janson C, Lindberg E. Incident chronic rhinosinusitis is associated with impaired sleep quality: results of the RHINE study. J Clin Sleep Med. 2019;15(6):899–905.

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