Gender differences in emotional burden in chronic rhinosinusitis: The role of sleep-related impairment

Background/Objectives: Chronic inflammatory conditions are increasingly conceptualized within biopsychosocial frameworks in which psychological processes shape illness experience and health-related quality of life (HRQoL). This study examined sex- and gender-related differences in emotional burden among patients with chronic rhinosinusitis with nasal polyps (CRSwNP), focusing on sleep disturbance as a potential factor associated with emotional distress. Methods: In a cross-sectional sample of 111 adults with CRSwNP, participants underwent clinical assessment and completed the Sino-Nasal Outcome Test. Independent-samples analyses examined sex differences in symptom severity and HRQoL domains. Hierarchical regression models tested whether emotional distress remained associated with sex after accounting for disease severity and sleep impairment. An exploratory mediation analysis with bootstrapped confidence intervals examined whether sleep disturbance accounted for this association. Results: Women reported greater emotional distress and sleep impairment than men despite comparable disease severity. Sex explained initial variance in emotional burden, while sleep impairment was the strongest predictor. Sex differences remained significant in the fully adjusted model. Mediation analyses suggested that sleep disturbance may be statistically associated with the relationship between sex and emotional distress. Conclusions: Emotional burden in CRSwNP reflects sex- and gender-related processes beyond clinical severity. Sleep disturbance may represent an important factor associated with emotional distress, supporting biopsychosocial models and integrated care.