Association between sleep-disordered breathing and self-reported sinusitis in adults in the United States: NHANES 2005

Abstract

Objectives

The association between sleep-disordered breathing (SDB) and sinusitis has been widely studied; however, research on SDB-related sleep problems and sinusitis are limited. This study aims to determine the relationship between SDB-related sleep problems, SDB symptom score, and sinusitis.

Methods

After the screening, data were analyzed from 3414 individuals (≥20 years) from the 2005–2006 National Health and Nutrition Examination Survey questionnaire. Data on snoring, daytime sleepiness, obstructive sleep apnea (snorting, gasping, or cessation of breathing while sleeping), and sleep duration were analyzed. The SDB symptom score was determined based on a summary of the scores of the above four parameters. Pearson chi-square test and logistic regression analysis were used in statistical analyses.

Results

After adjusting for confounders, self-reported sinusitis was strongly correlated with frequent apneas (OR: 1.950; 95% CI: 1.349–2.219), excessive daytime sleepiness (OR: 1.880; 95% CI: 1.504–2.349), and frequent snoring (OR: 1.481; 95% CI: 1.097–2.000). Compared to an SDB symptom score of 0, the higher the SDB symptom score, the higher the risk of self-reported sinusitis. For the subgroup analyses, this association was significant in females and across ethnic groups.

Conclusion

In the United States, SDB is significantly associated with self-reported sinusitis in adults. In addition, our study suggests that patients with SDB should be aware of the risk of developing sinusitis.

Keywords

sleep-disordered breathing sinusitis NHANES clinical study

Introduction

Sleep-disordered breathing (SDB) is highly prevalent in North America and is becoming a public health problem.^1,2 SDB is characterized by abnormal breathing during sleep,³ and includes obstructive sleep apnea (OSA), centric sleep apnea syndrome, sleep-related alveolar hypoventilation, and sleep-related hypoxemia⁴—with OSA being highly prevalent in the general population. SDB involves habitual snoring, excessive daytime sleepiness, choking or wheezing during sleep, and waking up frequently.⁵ Previous studies have shown that SDB can trigger sympathetic activation,⁶ low-grade systemic inflammation,⁷ endothelial dysfunction,⁸ and endocrine disruption,⁹ and these pathological processes facilitate the progression of chronic diseases, including cardiovascular disease, metabolic syndrome, and psychiatric disorders.^10–12

Chronic rhinosinusitis (CRS) is a chronic inflammatory change of one or more sinuses and mucous membranes of the nasal cavity that lasts for more than 12 weeks.¹³ The disease is characterized by nasal congestion, mucus or mucous nasal discharge, dizziness, headache, and even loss of sense of smell. Owing to the long duration of the disease and its recurrent nature, it greatly affects the patient’s quality of life, daily work, and physical and mental health of patients. Furthermore, recent studies have shown that acute attacks of CRS can cause poor sleep quality and excessive daytime sleepiness in patients.¹⁴ The etiology of CRS involves genetic, environmental, microbiological, inflammatory, and immune factors.¹⁵

We hypothesize that inflammatory SDB and sinusitis share similar inflammatory mechanisms, and that there is an association between these 2 entities. In line with this hypothesis, Magliulo et al. found that one or more CRS symptoms were present in 80% of patients with OSA.¹⁶ Although several studies have reported the association between SDB and sinusitis, few researchers have addressed the association between their correlates. This research examined the correlation between SDB, SDB symptom score, and self-reported sinusitis in US adults. This association was also evaluated by race and sex.

Patients and methods

Data sources

This study extracted and integrated data from the National Health and Nutrition Examination Survey (NHANES) 2005–2006, which is the only cycle that included information on sinus infection and sleep disorders. This study includes data on allergy symptom questionnaires, sleep disorder questionnaires, and demographic information from NHANES 2005–2006 with data extracted from a total of 3414 cases with full details of sinusitis, sleep disorders, and multivariable model covariates. All procedures and content were approved by the ethical review committee of the National Center for Health Statistics (NCHS).

Assessment of SDB

Sleep duration was classified as ≤5, 6, 7, 8, and ≥9 h (SLD010H). Snoring and OSA (snorting, gasping, or cessation of breathing while sleeping) were categorized as rare (0–2 nights per week), occasional (3–4 nights per week), or frequent (≥5 nights per week) (SLQ030 and SLQ040). Daytime sleepiness was categorized as rare (0–1 night per month), occasional (2–4 nights per month), or frequent (≥5 nights per month) (SLQ120).

SDB symptom score was assessed by calculating a summary score (ranging from 0 to 4), as previously described by our group.^17,18 Sleep duration of ≤5 h/day, occasional or frequent snoring, occasional or frequent apneas, and frequent daytime sleepiness was individually assigned a score of 1.

Definition of self-reported sinusitis

The sinusitis information was gained from the NHANES 2005–2006 questionnaire on allergies. Self-reported sinusitis was described by the questionnaire question, “During the past 12 months, did a doctor tell you that you have a sinus infection?” (AGQ120). If the answer was “yes,” the participant was classified as having self-reported sinusitis.¹⁹

Sociodemographic variables

For the factors associated with self-reported sinusitis, we modified the regression model. Details on age, sex, race/ethnicity, education level (less than high school, completed high school, and more than high school), marital status (married or living with others, unmarried, or other), and poverty income ratio (PIR, ≤1 under poverty level, >1 above poverty level) were all obtained through questionnaires. Body mass index (BMI) was classified as normal <25 kg/m², overweight 25–30 kg/m², or obese ≥30 kg/m²). Various behaviors were considered unhealthy, such as smoking (at least 100 cigarettes per lifetime or no smoking) and drinking (at least 12 drinks per year or no drinking). Physical and mental health status was obtained through questionnaires, the number of days of mental turmoil in the last 30 days (<5 days, 5–15 days, ≥16 days), and the number of physically unhealthy days in the last 30 days (<5 days, 5–15 days, ≥16 days).

Statistical analysis

IBM SPSS Statistics 26.0 was used for statistical analysis. As described in the NHANES analysis criteria, we considered cluster, multilevel sampling of NHANES data. Sociodemographic characteristics, lifestyle factors, and questionnaire results were described using weighted percentages. The proportion of categorical variables was compared by Pearson’s χ2 tests. The association between SDB and SDB symptom score and self-reported sinusitis was investigated in a multivariate logistic regression model. The multivariate regression model was adjusted for age, sex, race, education level, BMI, PIR, marital status, smoking status, alcohol intake, mental health status, and physical health status.

Results

Study population

The NHANES 2005–2006 survey included 10348 patients with sleep disorders; of these, 3414 patients (479 [15.6%] with self-reported sinusitis and 2935 [84.6%] without self-reported sinusitis) met the inclusion and exclusion criteria. Sex, age, level of education, BMI, mental health status, and physical health status were statistically associated with the occurrence of self-reported sinusitis (P < 0.05) (Table 1). In addition, there was a predominance of females (50.7%), individuals aged 22–44 years (59.6%), non-Hispanic white people (73.6%), high school graduates (59.6%), and PIR >1 (89.8%) in our cohort.

Table 1.

Sample Size and Sociodemographic Characteristics of Adults from NHANES 2005–2006.

Characteristics	Total		Self-reported non- sinusitis		Self-reported sinusitis		x²	P value
Characteristics	N	Weighted	N	Weighted	N	Weighted	x²	P value
Sex
Male, % (SE)	1686	49.3 (0.7)	1514	88.7 (1.1)	172	11.3 (1.1)	45.351	<0.001
Female, % (SE)	1728	50.7 (0.7)	1421	80.3 (1.3)	307	20.7 (1.3)
Age (years)
20–44, % (SE)	1715	50.7 (2.2)	1478	85.4 (1.1)	237	14.6 (1.1)	8.903	0.018
45–70, % (SE)	1206	39.8 (1.5)	1017	82.3 (1.6)	189	17.7 (1.6)
≥70, % (SE)	493	9.5 (1.2)	440	87.9 (1.1)	53	12.1 (1.1)
Race/ethnicity
Mexican American, % (SE)	646	7.2 (1.0)	593	90.5 (0.9)	53	9.5 (0.9)	9.084	0.217
Other Hispanic, % (SE)	108	3.4 (0.7)	93	85.6 (4.8)	15	14.4 (4.8)
Non‐Hispanic White, % (SE)	1765	73.6 (2.6)	1485	83.6 (1.2)	280	16.4 (1.2)
Non‐Hispanic Black, % (SE)	762	10.7 (1.8)	651	85.9 (2.3)	111	14.1 (2.3)
Other race, % (SE)	133	5.1 (0.6)	113	83.0 (3.8)	20	17.0 (3.8)
Education level
Less than High School, % (SE)	873	16.3 (1.5)	783	88.5 (1.0)	90	11.5 (1.0)	12.490	0.010
Completed High School, % (SE)	821	24.6 (1.1)	721	85.7 (1.6)	100	14.3 (1.6)
More than High School, % (SE)	1720	59.1 (2.2)	1431	82.7 (1.3)	289	17.3 (1.3)
Marital status
Married or living with others, % (SE)	2329	70.8 (1.5)	2002	84.1 (1.4)	327	15.9 (1.4)	3.993	0.396
Unmarried, % (SE)	500	14.0 (1.1)	438	87.3 (2.4)	62	12.7 (2.4)
Other, % (SE)	585	15.3 (0.8)	495	83.0 (1.9)	90	17.0 (1.9)
Smoking status
Yes, % (SE)	1606	48.4 (1.4)	1370	84.1 (1.1)	236	15.9 (1.1)	0.182	0.722
No, % (SE)	1808	51.6 (1.4)	1565	84.7 (1.4)	243	15.3 (1.4)
Alcohol consumption
Yes, % (SE)	2386	74.9 (1.8)	2049	84.8 (1.1)	337	15.2 (1.1)	1.294	0.288
No, % (SE)	1028	25.1 (1.8)	886	83.2 (1.6)	142	16.8 (1.6)
PIR
≤1, % (SE)	555	10.2 (0.8)	493	86.3 (2.0)	62	13.7 (2.0)	0.994	0.445
>1, % (SE)	2859	89.8 (0.8)	2442	84.2 (1.2)	417	15.8 (1.2)
BMI
Normal, % (SE)	1032	32.9 (1.6)	912	86.9 (1.6)	120	13.1 (1.6)	34.645	0.003
Overweight, % (SE)	1182	32.9 (0.8)	1039	87.2 (1.5)	143	12.8 (1.5)
Obese, % (SE)	1200	34.2 (1.5)	984	79.4 (1.9)	216	20.6 (1.9)
Mental unhealthy days
<5, % (SE)	2729	79.0 (1.2)	2394	86.5 (1.2)	335	13.5 (1.2)	52.421	<0.001
5–15, % (SE)	432	13.8 (0.9)	353	79.9 (1.8)	79	20.1 (1.8)
≥16, % (SE)	253	7.2 (0.6)	188	70.5 (3.4)	65	29.5 (3.4)
Physical unhealthy days
<5, % (SE)	2744	81.6 (0.6)	2411	86.8 (0.9)	333	13.2 (0.9)	68.461	<0.001
5–15, % (SE)	405	11.7 (0.6)	320	74.5 (2.9)	85	25.5 (2.9)
≥16, % (SE)	265	6.7 (0.6)	204	72.3 (3.7)	61	27.7 (3.7)

Association between SDB and self-reported sinusitis

Table 2 shows the logistic regression on self-reported sinusitis and the percentage of self-reported sinusitis and self-reported non-sinusitis samples with SDB-related sleep problems. Self-reported sinusitis occurred in 20.7% of samples with ≤5 hours of sleep; 19.7% of snoring samples; 26.3% of samples who snort/stop breathing ≥5 nights/week; 24.9% of samples with daytime sleepiness ≥5 times/month; and in 28.7% of samples with SDB symptom scores of ≥3. When compared to a total sleep duration of 7 hours, a sleep duration of 5 hours or less was significantly linked to self-reported sinusitis (OR: 1.457; 95% CI: 1.012–2.097); however, the relationship was attenuated and not statistically significant after adjusting for confounders (P > 0.05). In model 1, frequent snoring/stopping of breathing (≥5 nights/week), frequent daytime sleepiness (≥5 times/month), and frequent snoring (≥5 nights/week) were related to self-reported sinusitis.

Table 2.

Association between Sociodemographic Characteristics, Sleep-Disordered Breathing, and Self-Reported Sinusitis in Our Cohort.

Sleep variables	Self-reported non-sinusitis [n, (%, SE)]	Self-reported sinusitis [n, (%, SE)]	Unadjusted		Multivariable model 1
Sleep variables	Self-reported non-sinusitis [n, (%, SE)]	Self-reported sinusitis [n, (%, SE)]	OR	95% CI	OR	95% CI
Sleep duration (hours)
≤5 hrs	409 (79.3, 2.5)	93 (20.7, 2.5)	1.457 (1.012–2.097)		1.334(0.945–1.884)
6 hrs	662 (85.5, 1.7)	103 (14.5, 1.7)	0.948 (0.6801.321)		0.917 (0.639–1.314)
7 hrs	830 (84.8, 1.7)	132 (15.2, 1.7)	1 (referent)		1 (referent)
8 hrs	804 (85.9, 1.3)	114 (14.1, 1.3)	0.911 (0.624–1.330)		0.909 (0.626–1.319)
≥9 hrs	230 (82.9, 3.4)	37 (17.1, 3.4)	1.150 (0.654–2.023)		1.167 (0.670–2.032)
Snoring (nights/week)
0–2	1539 (86.0, 1.4)	219(14.0, 1.4)	1 (referent)		1 (referent)
3–4	425 (87.4, 1.0)	76(12.6, 1.0)	0.882 (0.649–1.198)		0.790 (0.547–1.141)
≥5	871 (80.3, 1.4)	184(19.7, 1.4)	1.497 (1.202–1.864)		1.481 (1.097–2.000)
apnea (nights/week)
0–2	2601 (85.5, 1.1)	398 (14.5, 1.1)	1 (referent)		1 (referent)
3–4	170 (81.2, 2.4)	33 (18.8, 2.4)	1.361 (0.918–2.019)		1.416 (0.988–2.028)
≥5	164 (73.7, 3.0)	48 (26.3, 3.0)	2.101 (1.418–3.114)		1.950 (1.349–2.219)
Daytime sleepiness (times/month)
0–1	1690 (88.4, 1.4)	208 (11.6, 1.4)	1 (referent)		1 (referent)
2–4	753 (82.6, 1.4)	135 (17.4, 1.4)	1.603 (1.087–2.364)		1.388 (0.909–2.119)
≥5	492 (75.1, 2.4)	136 (24.9, 2.4)	2.519 (1.948–3.257)		1.880 (1.504–2.349)
SDB symptom score
0	1143 (87.7, 1.2)	137 (12.3, 1.2)	1 (referent)		1 (referent)
1	1146 (85.2, 1.2)	183 (14.8, 1.2)	1.244 (1.059–1.462)		1.198 (1.004–1.428)
2	472 (80.3, 1.1)	104 (19.7, 1.1)	1.756 (1.356–2.274)		1.660 (1.265–2.179)
≥3	174 (71.3, 2.8)	55 (28.7, 2.8)	2.872 (2.0056–4.013)		2.263 (1.590–3.223)

Data are expressed as odds ratios and 95% confidence intervals. Bold numbers indicate p < 0.05. Multivariable model 1 was adjusted for sex, age, race, education level, marital status, poverty income ratio, body mass index, smoking status, alcohol consumption, physical health status, and mental health status.

After adjusting for confounding factors, increasing SDB symptom scores were significantly and positively associated with self-reported sinusitis (Figure 1).

Figure 1.

Association between SDB symptom score and self-reported sinusitis. Multivariable model 1 was adjusted for sex, age, race, education level, marital status, poverty income ratio, body mass index, smoking status, alcohol consumption, physical health status, and mental health status.

Association between increasing SDB symptom score and self-reported sinusitis by race and sex

Table 3 shows the effect of race on the relationship between increasing SDB symptom score and self-reported sinusitis. In multivariate models, we found that increasing SDB symptom scores was positively associated with self-reported sinusitis across all ethnic groups. Table 4 shows the effect of sex on the relationship between increasing SDB symptom scores and self-reported sinusitis. In multivariate models, an increasing SDB symptom score was only associated with self-reported sinusitis in females, and the association was significantly attenuated and not statistically significant in males.

Table 3.

Association between SDB Symptom Score and Self-Reported Sinusitis by Race.

SDB symptom score	Self-reported non-sinusitis [n, (%, SE)]	Self-reported sinusitis [n, (%, SE)]	Unadjusted		Multivariable model 1
SDB symptom score	Self-reported non-sinusitis [n, (%, SE)]	Self-reported sinusitis [n, (%, SE)]	OR	95% CI	OR	95% CI
Non‐Hispanic White
0	614 (86.6, 1.6)	87 (13.4, 1.6)	1 (referent)		1 (referent)
1	574 (84.7, 1.4)	104 (15.3, 1.4)	1.165 (0.932–1.456)		1.117 (0.882–1.416)
2	220 (79.6, 1.6)	56 (20.4, 1.6)	1.653 (1.194–2.289)		1.578 (1.096–2.273)
≥3	77 (69.4, 3.7)	33 (30.6, 3.7)	2.839 (1.874–4.301)		2.354 (1.386–3.997)
Other races
0	529 (91.1, 1.6)	50 (8.9, 1.6)	1 (referent)		1 (referent)
1	572 (86.6, 2.0)	79 (13.4, 2.0)	1.591 (0.916–2.763)		1.688 (1.020–2.794)
2	252 (82.0, 2.3)	48 (18.0, 2.3)	2.259 (1.335–3.821)		2.326 (1.412–3.832)
≥3	97 (75.5, 5.6)	22 (24.5, 5.6)	3.348 (1.365–8.216)		2.611 (1.203–5.668)

Table 4.

Association between SDB Symptom Score and Self-Reported Sinusitis by Gender.

SDB symptom score	Self-reported non-sinusitis [n, (%, SE)]	Self-reported sinusitis [n, (%, SE)]	Unadjusted		Multivariable model 1
SDB symptom score	Self-reported non-sinusitis [n, (%, SE)]	Self-reported sinusitis [n, (%, SE)]	OR	95% CI	OR	95% CI
Male
0	488 (91.0, 2.2)	42 (9.0, 2.2)	1 (referent)		1 (referent)
1	619 (89.6, 1.4)	67 (10.4, 1.4)	1.176 (0.641–2.159)		1.140 (0.604–2.153)
2	296 (85.6, 1.1)	42 (14.4, 1.1)	1.696 (0.937–3.070)		1.396 (0.757–2.575)
≥3	111 (82.4, 3.7)	21 (17.6, 3.7)	2.160 (0.937–4.981)		1.886 (0.689–5.166)
Femal
0	655 (85.5, 1.5)	95 (14.5, 1.5)	1 (referent)		1 (referent)
1	527 (80.4, 1.9)	116 (19.6, 1.9)	1.439 (1.055–1.964)		1.235 (0.917–1.662)
2	176 (71.6, 2.5)	62 (28.4, 2.5)	2.349 (1.653–3.339)		1.909 (1.336–2.730)
≥3	63 (57.0, 4.8)	34 (43.0, 4.8)	4.457 (2.751–7.315)		2.853 (1.808–4.502)

Discussion

This research investigated the relationship between SDB and self-reported sinusitis in adults (≥20 years) from NHANES 2005–2006. After adjusting for confounders, we found that frequent snoring (≥5 nights per week), frequent daytime sleepiness (≥5 times per month), and frequent apneas (≥5 nights per week) were related to self-reported sinusitis. Participants with an SDB symptom score ≥3 had 2.263 times higher odds of having self-reported sinusitis than those with an SDB symptom score of 0. Furthermore, increasing SDB symptom scores were significantly and positively associated with self-reported sinusitis in females and all racial groups after adjusting for confounders.

The relationship between SDB and sinusitis has been extensively studied, and numerous studies have shown that patients with CRS are at significantly higher risk of developing SDB. It was found that the prevalence of OSA was significantly higher in patients with CRS than in the general population.²⁰ Similarly, Sunderram et al. found an exceedingly high prevalence of OSA among dust-exposed World Trade Center responders. Compared to no CRS, new and worsening CRS is a significant risk factor for OSA.²¹ In addition, the risk of developing OSA in the CRS population is also associated with race. A cross-sectional study found that African American patients with CRS had a higher risk of developing OSA compared to white patients.²² However, there are few studies on the effect of SDB on the development of rhinosinusitis.

By analyzing the data of KNHANES 2005–2009, Kim et al. found that sleep duration in Korean older adults may be negatively associated with CRS.²³ Furthermore, a population-based cohort study by Kao et al. found that participants with OSA of both sexes were at a higher risk of developing CRS than those without OSA.²⁴ These results suggest a correlation between sleep disorders and sinusitis. In the current research, there was a significant and positive association between increasing SDB symptom scores and self-reported sinusitis, but no significant association between sleep duration and sinusitis was seen after adjusting for confounders.

The potential mechanism between SDB and sinusitis remains unclear but may be related to chronic inflammation and oxidative stress. Previous studies have reported that several factors have been implicated in OSA, including oxidative stress, inflammation, and endothelial dysfunction.²⁵ OSA-induced hypoxia can trigger the release of inflammatory cytokines that trigger upper airway inflammation,²³ which may lead to anatomic upper airway narrowing, abnormal upper airway reflexes, upper airway collapse, and inspiratory pharyngeal muscle dysfunction. These anatomical abnormalities may induce symptoms such as nasal congestion and inevitably cause nocturnal open-mouth breathing in patients with SDB, which may account for the dryness of the upper airway in such patients. In addition, OSA may increase immunological heterogeneity in patients with eosinophilic CRS and nasal polyps.²⁶ Inflammation due to hypoxia in OSA causes the release of inflammatory factors, including serum C-reactive protein, nuclear factor-κB, hypoxia-inducible factor-1α, and tumor necrosis factor-α.^27–29 These inflammatory mediators can activate inflammatory pathways, leading to endothelial dysfunction, metabolic dysregulation, and sympathetic excitation.³⁰ Therefore, chronic inflammation and anatomical abnormalities of the upper airway caused by SDB may cause microbial changes in the nasal cavity and nasal-sinus mucosal edema, and induce CRS. Similarly, the accumulation of common inflammatory cells in chronic sinusitis and the release of various inflammatory factors play a key role in the pathophysiology of chronic sinusitis.³¹ In addition, these inflammatory mediators induce proinflammatory responses and worsen CRS.^32–34 Since the NHANES database contains only cross-sectional data, this study can qualify only as an association study. Therefore, we cannot determine the causal relationship between SDB and self-reported sinusitis and can only suggest possible mechanisms.

Furthermore, a potential mechanism between SDB and CRS may also be associated with laryngopharyngeal reflux (LPR). There are 3 main pathogenic mechanisms of CRS caused by LPR: (1) effect of LPR on mucous membranes: direct effect of the reflux on the mucosa of the nose and sinuses, leading to edema of the mucosa and impairment of the mucosal ciliary clearance function. The above-mentioned lesions leads to obstruction and infection at the opening of the sinuses;^35,36 (2) vagus nerve-mediated neurogenic mechanisms: LRP through disorders of the autonomic nervous system, which may lead to edema of the nasal-sinus and secondary obstruction at the opening of the sinuses;³⁷ (3) helicobacter pylori: LRP leads to colonization of the sinuses by Helicobacter pylori and may be associated with the development of sinusitis.³⁸ Similarly, LPR is also associated with the occurrence of SDB. LPR may cause neuropathy and impaired pharyngeal sensitivity, leading to collapse of the upper airway.³⁹ LPR also leads to mucosal damage due to inflammation, and chronic inflammation leads to direct tissue edema and airway narrowing, which promotes OSA.⁴⁰

Our research has limitations. First, in terms of the diagnosis of SDB, the NHANES database only contains questionnaires for sleep disorders; as of now, no data on any SDB-related clinical tests, such as polysomnography, have been added. Therefore, we only used self-reported data to define SDB which makes the SDB diagnosis inaccurate. Similarly, the diagnosis of sinusitis was defined only by a questionnaire. The recall bias of subjective reports and the absence of relevant clinical symptoms in the early stages of many patients with sinusitis inevitably led to biased findings. In addition, the duration of sinusitis symptoms could not be determined by the questionnaire, and acute and chronic sinusitis could not be separated. However, self-reporting may be considered valuable in large-scale epidemiological studies. Second, the results of this study are only representative of the US population and thus cannot be extended globally. Third, as the present research is a cross-sectional survey, the causality of this association is limited, and more large-scale longitudinal cohort studies are needed for research validation.

In conclusion, SDB was significantly associated with self-reported sinusitis in adults (≥20 years) in the United States after adjusting for confounders. Furthermore, increasing SDB symptom scores were significantly and positively correlated with self-reported sinusitis independent of potential confounding factors. In the subgroup analysis, the relationship between increasing SDB symptom scores and self-reported sinusitis was significant in females, but this association did not differ by race. These findings indicate that patients with SDB should be aware of the risk of developing sinusitis. In addition, the potential mechanism between SDB and sinusitis still needs further investigation.

Footnotes

Acknowledgements

Not applicable.

Author contributions

Zezhang Tao, Tian Chen, Yuqin Deng, Shiming Chen, and Fen Li conceived the idea of the study; Tian Chen, Yang Xi, Fen Li analyzed the data; Tian Chen, Yuqin Deng, Fen Li, Yang Xi, Zezhang Tao, Shiming Chen interpreted the results; Tian Chen and Fen Li wrote the paper; all authors discussed the results and revised the manuscript.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was funded by the National Natural Science Foundation of China (Reference Numbers: 81372880).

Availability of data and materials

All the data of our study come from the National Health and Nutrition Examination Survey 2005–2006. Relevant data can be obtained in BeginYear = 2005.

Ethics approval and consent to participate

All NHANES investigations were approved by the National Center for Health Statistics Research Ethics Review Board (ERB), and the ERB protocol number of NHANES 2005–2006 was #2005-06.

ORCID iD

Tian Chen

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Association between sleep-disordered breathing and self-reported sinusitis in adults in the United States: NHANES 2005–2006

Abstract

Objectives

Methods

Results

Conclusion

Keywords

Introduction

Patients and methods

Data sources

Assessment of SDB

Definition of self-reported sinusitis

Sociodemographic variables

Statistical analysis

Results

Study population

Association between SDB and self-reported sinusitis

Association between increasing SDB symptom score and self-reported sinusitis by race and sex

Discussion

Footnotes

Acknowledgements

Author contributions

Declaration of conflicting interests

Funding

Availability of data and materials

Ethics approval and consent to participate

ORCID iD

References