Chronic Rhinosinusitis and Obstructive Sleep Apnea: CPAP Reservoir Bacterial Colonization Is Not Associated with Sinus Culture Positivity

Rosa Lipin,Anita Deshpande,Sarah Wise,John Delgaudio,Zara Patel

doi:10.3390/sinusitis1010044

Rosa Lipin, Anita Deshpande + Show 3 more

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https://doi.org/10.3390/sinusitis1010044

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Journal: Sinusitis	Publication Date: Mar 9, 2016
Citations: 12	License type: CC BY 4.0

Affiliation: Emory University, Stanford University

Abstract

Chronic rhinosinusitis (CRS) and obstructive sleep apnea (OSA) are both highly prevalent chronic diseases in the United States. Association between culture positivity of CPAP machines and sinus samples has not been studied in patients with both disease states. Our objective was to compare the microbes present in the sinus cavities and CPAP reservoirs of patients with both CRS and OSA. Patients from an academic tertiary care Rhinology practice were identified with both CRS and OSA and enrolled prospectively. Inclusion criteria included age over 18 years; diagnosis of OSA by sleep study; regular CPAP use; and an active diagnosis of CRS. Exclusion criteria included treatment with antibiotics or cleaning of the CPAP reservoir in the month prior. Cultures were taken from participants’ sinus cavities and CPAP reservoirs and resulting microbial growth was compared. The most common organisms on CPAP culture were Enterobacter cloacae and Acinetobacter baumanii, whereas the most common on sinus culture were Staphyloccoccus aureus and Pseudomonas aeruginosa. Microbial growth from the sinus cavities and the CPAP reservoirs were not concordant in any of our patients. There is no association between bacterial colonization of the CPAP reservoir and the sinus cavities of those with CRS and OSA based on microbiologic cultures.

Highlights

Chronic rhinosinusitis (CRS) is an end result of over 12 weeks of symptoms from underlying inflammation of the lining of the paranasal cavities, leading to over 18.3 million office visits a year [1].Patients with CRS see primary care providers twice as much as those without the disease, and are five times more likely to be prescribed antibiotics [2]
After approval was obtained from the Institutional Review Board, study participants were identified at an academic tertiary care Rhinology practice using ICD-9 codes for obstructive sleep apnea and chronic rhinosinusitis
Ten patients meeting inclusion criteria were enrolled in the study and nine had both sinonasal and continuous positive airway pressure (CPAP) reservoir samples obtained

Summary

Introduction

Patients with CRS see primary care providers twice as much as those without the disease, and are five times more likely to be prescribed antibiotics [2]. The presentation of this disease can be highly variable, and the etiology remains poorly understood. As there is currently no standardized therapy for CRS, patients are managed using a combination of strategies, including systemic and topical corticosteroids, antimicrobial agents, intranasal saline, immune modulators, and endoscopic sinus surgery [4]. Obstructive sleep apnea (OSA) is another common chronic disease, found in 9%–26% of middle aged adults and characterized by the presence of five or more episodes of complete (apnea) or partial (hypopnea) airflow obstruction per hour while asleep [5].

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