Sleep quality burden in chronic rhinosinusitis with nasal polyps and its modulation by dupilumab

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is associated with a substantial burden on patients' quality of life and impaired sleep quality. The most common CRSwNP endotype is characterized by type 2 inflammation, with enhanced production of interleukin (IL)-4, IL-5, and IL-13. Dupilumab is a monoclonal antibody against IL-4 receptor-a, which inhibits both IL-4 and IL-13 signaling, and was recently approved for treatment of CRSwNP. Objective: We investigated the effect of dupilumab on the sleep quality of patients with CRSwNP in a real-life setting. Methods: Patients were evaluated at baseline and after 1 and 3 months of dupilumab treatment by means of the Epworth sleepiness scale (ESS), insomnia severity index (ISI), Pittsburgh sleep quality index (PSQI), and sinonasal outcome test 22 (SNOT-22) sleep domain. Results: A total of 29 consecutive patients were enrolled, and their baseline sleep quality assessment were as follows: ESS of 7.9 (+/- 4.5); ISI of 13.1 (+/- 6.2); PSQI of 9.2 (+/- 3.7); and SNOT-22 sleep domain of 12.1 (+/- 4.2). Excessive daily sleepiness, insomnia, and globally impaired sleep quality were present in 24.1%, 79.3%, and 93.1% respectively. Treatment with dupilumab was associated with significant improvement in ESS, ISI, PSQI, and SNOT-22 sleep domain with concomitant reduction of the proportion of patients with insomnia and globally impaired sleep quality. Conclusion: CRSwNP was associated with a significant impact on global sleep quality, in particular, insomnia, and treatment with dupilumab induced a rapid improvement (after 1 single month of treatment) in all the sleep quality parameters, suggesting that sleep disturbances should be more carefully evaluated as an additional outcome in these patients. (c) 2023 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.