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Current Allergy and Asthma Reports
Published in: Current Allergy and Asthma Reports 2/2010

01-03-2010

Congestion and Sleep Impairment in Allergic Rhinitis

Authors: Timothy J. Craig, Amir Sherkat, Sahar Safaee

Published in: Current Allergy and Asthma Reports | Issue 2/2010

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Abstract

Allergic rhinitis is a prevalent disease in developed nations, and its prevalence has been increasing throughout the world. Nasal congestion is the most common and bothersome symptoms of rhinitis. Congestion is associated with sleep-disordered breathing and is thought to be a key cause of sleep impairment in individuals with rhinitis. The end result is a decrease in quality of life and productivity and an increase in daytime sleepiness. Treatment with intranasal corticosteroids has been shown to reduce nasal congestion. Data on sleep-related end points from clinical trials of intranasal corticosteroids indicate that this reduction is associated with improved sleep, reduced daytime fatigue, and improved quality of life. Other therapies, such as montelukast, also have a positive influence on congestion and sleep. This review examines nasal congestion and the associated sleep impairment of allergic rhinitis patients. It explores the adverse effects of disturbed sleep on quality of life and how these conditions can be reduced by therapies that decrease congestion.
Literature
1.
Bauchau V, Durham SR: Prevalence and rate of diagnosis of allergic rhinitis in Europe. Eur Respir J 2004, 24:758–764.CrossRefPubMed
2.
Derebery J, Meltzer E, Nathan RA, et al.: Rhinitis symptoms and comorbidities in the United States: Burden of Rhinitis in America survey. Otolaryngol Head Neck Surg 2008, 139:198–205.CrossRefPubMed
3.
Rappai M, Collop N, Kemp S: The nose and sleep-disordered breathing. What we know and what we do not know. Chest 2003, 124:2309–2323.CrossRefPubMed
4.
•• Meltzer EO, Blaiss MS, Derebery MJ, et al.: Burden of allergic rhinitis: results from the Pediatric Allergies in America survey. J Allergy Clin Immunol 2009, 124(3 Suppl):S43– S70. This is the most up-to-date article on the burden of rhinitis specifically on children.PubMed
5.
•• Meltzer EO, Nathan R, Derebery J, et al.: Sleep, quality of life, and productivity impact of nasal symptoms in the United States: findings from the Burden of Rhinitis in America survey. Allergy Asthma Proc 2009, 30:244–254. This is the most up-to-date article on the burden of rhinitis on patients.CrossRefPubMed
6.
Blaiss M, Reigel T, Philpot E: A study to determine the impact of rhinitis on sufferers’ sleep and daily routine [abstract]. J Allergy Clin Immunol 2005, 115:S197.CrossRef
7.
Stempel DA, Woolf R: The cost of treating allergic rhinitis. Curr Allergy Asthma Rep 2002, 2:223–230.CrossRefPubMed
8.
Leynaert B, Neukirch C, Liard R: Quality of life in allergic rhinitis and asthma. A population-based study of young adults. Am J Respir Crit Care Med 2000, 162:1391–1396.PubMed
9.
Meltzer EO: Quality of life in adults and children with allergic rhinitis. J Allergy Clin Immunol 2001, 108:S45–S53.CrossRefPubMed
10.
Stull DE, Roberts L, Frank L, Heithoff K: Relationship of nasal congestion with sleep, mood, and productivity. Curr Med Res Opin 2007, 23:811–819.CrossRefPubMed
11.
McNicholas WT, Tarlo S, Cole P, et al.: Obstructive sleep apneas during sleep in patients with seasonal allergic rhinitis. Am Rev Respir Dis 1982, 126:625–628.PubMed
12.
Staevska MT, Mandajieva MA, Dimitrov VD: Rhinitis and sleep apnea. Curr Allergy Asthma Rep 2004, 4:193–199.CrossRefPubMed
13.
Lavie P, Gertner R, Zomer J, et al.: Breathing disorders in sleep associated with “microarousals” in patients with allergic rhinitis. Acta Otolaryngol 1981, 92:529–533.CrossRefPubMed
14.
Kramer MF, De La Chaux R, Derher A, et al.: Allergic rhinitis does not constitute a risk factor for obstructive sleep apnea syndrome. Acta Otolaryngol 2001, 121:494–499.CrossRefPubMed
15.
Young T, Finn L, Kim H; The University of Wisconsin Sleep and Respiratory Research Group: Nasal obstruction as a risk factor for sleep-disordered breathing. J Allergy Clin Immunol 1997, 99:S757–S762.CrossRefPubMed
16.
• Rimmer J, Downie S, Bartlett DJ, et al.: Sleep disturbance in persistent allergic rhinitis measured using actigraphy. Ann Allergy Asthma Immunol 2009, 103:190–194. This study showed that actigraphy may be an effective way to measure sleep disturbance in rhinitis and the response to therapy.CrossRefPubMed
17.
Sogut A, Altin R, Uzun L, et al.: Prevalence of obstructive sleep apnea syndrome and associated symptoms in 3–11 year-old Turkish children. Pediatr Pulmonol 2005, 39:251–256.CrossRefPubMed
18.
•• Bixler EO, Vgontzas AN, Lin HM, et al.: Sleep disordered breathing in children in a general population sample: prevalence and risk factors. Sleep 2009, 32:731–736. This is a new and well-done article on sleep disturbance in children.PubMed
19.
Janson C, De Backer W, Gislason T, et al.: Increased prevalence of sleep disturbances and daytime sleepiness in subjects with bronchial asthma: a population study of young adults in three European countries. Eur Respir J 1996, 9:2132–2138.CrossRefPubMed
20.
Craig TJ, McCann JL, Gurevich F, et al.: The correlation between allergic rhinitis and sleep disturbance. J Allergy Clin Immunol 2004, 114:S139–S145.CrossRefPubMed
21.
Craig TJ, Teets S, Lehman EB, et al.: Nasal congestion secondary to allergic rhinitis as a cause of sleep disturbance and daytime fatigue and the response to topical nasal corticosteroids. J Allergy Clin Immunol 1998, 101:633–637.CrossRefPubMed
22.
Stuck BA, Czajkowski J, Hagner AE, et al.: Changes in daytime sleepiness, quality of life, and objective sleep patterns in seasonal allergic rhinitis: a controlled clinical trial. J Allergy Clin Immunol 2004, 113:663–668.CrossRefPubMed
23.
Corey JP, Houser SM, Ng BA: Nasal congestion: a review of its etiology, evaluation, and treatment. Ear Nose Throat J 2000, 79:690–693, 696, 698.PubMed
24.
Nathan RA, Eccles R, Howarth PH, et al.: Objective monitoring of nasal patency and nasal physiology in rhinitis. J Allergy Clin Immunol 2005, 115:S442–S459.CrossRefPubMed
25.
26.
Landstra AM, Postma DS, Boezen HM, et al.: Role of serum cortisol levels in children with asthma. Am J Respir Crit Care Med 2002, 165:708–712.PubMed
27.
Reinberg A, Gervais P, Levi F, et al.: Circadian and circannual rhythms of allergic rhinitis: an epidemiologic study involving chronobiologic methods. J Allergy Clin Immunol 1988, 81:51–62.CrossRefPubMed
28.
Impact of Nasal Congestion Among Allergic Rhinitis Sufferers. An Internet Survey of 2002 People. New York: Roper Public Affairs Group of NOP World; 2004.
29.
Juniper EF, Rohrbaugh T, Meltzer EO: A questionnaire to measure quality of life in adults with nocturnal allergic rhinoconjunctivitis. J Allergy Clin Immunol 2003, 111:484–490.CrossRefPubMed
30.
Canova CR, Downs SH, Knoblauch A, et al.: Increased prevalence of perennial allergic rhinitis in patients with obstructive sleep apnea. Respiration 2004, 71:138–143.CrossRefPubMed
31.
Young T, Finn L, Palta M: Chronic nasal congestion at night is a risk factor for snoring in a population-based cohort study. Arch Intern Med 2001, 161:1514–1519.CrossRefPubMed
32.
Pitt AD, Smith AF, Lindsell L, et al.: Economic and quality-of-life impact of seasonal allergic conjunctivitis in Oxfordshire. Ophthalmic Epidemiol 2004, 11:17–33.CrossRefPubMed
33.
Sack R, Conradi L, Beaton A, et al.: Antibody array characterization of inflammatory mediators in allergic and normal tears in the open and closed eye environments. Exp Eye Res 2007, 85:528–538.CrossRefPubMed
34.
Tashiro M, Mochizuki H, Iwabuchi K, et al.: Roles of histamine in regulation of arousal and cognition: functional neuroimaging of histamine H1 receptors in human brain. Life Sci 2002, 72:409–414.CrossRefPubMed
35.
Mullington JM, Hinze-Selch D, Pollmacher T: Mediators of inflammation and their interaction with sleep: relevance for chronic fatigue syndrome and related conditions. Ann N Y Acad Sci 2001, 933:201–210.PubMedCrossRef
36.
Krouse HJ, Davis JE, Krouse JH: Immune mediators in allergic rhinitis and sleep. Otolaryngol Head Neck Surg 2002, 126:607–613.CrossRefPubMed
37.
Aoyagi M, Watanabe H, Sekine K, et al.: Circadian variation in nasal reactivity in children with allergic rhinitis: correlation with the activity of eosinophils and basophilic cells. Int Arch Allergy Immunol 1999, 120:95–99.CrossRefPubMed
38.
Vgontzas AN, Zoumakis E, Bixler EO, et al. : Adverse effects of modest sleep restriction on sleepiness, performance, and inflammatory cytokines. J Clin Endocrinol Metab 2004, 89:2119–2126.CrossRefPubMed
39.
Woodson BT, Brusky LT, Saurajen A, Jaradeh S: Association of autonomic dysfunction and mild obstructive sleep apnea. Otolaryngol Head Neck Surg 2004, 130:643–648.CrossRefPubMed
40.
Marshall PS, O’Hara C, Steinberg P: Effects of seasonal allergic rhinitis on selected cognitive abilities. Ann Allergy Asthma Immunol 2000, 84:403–410.CrossRefPubMed
41.
Wilken JA, Berkowitz R, Kane R: Decrements in vigilance and cognitive functioning associated with ragweed-induced allergic rhinitis. Ann Allergy Asthma Immunol 2002, 89:372–380.CrossRefPubMed
42.
Kessler RC, Almeida DM, Berglund P, et al.: Pollen and mold exposure impairs the work performance of employees with allergic rhinitis. Ann Allergy Asthma Immunol 2001, 87:289–295.CrossRefPubMed
43.
Lack G: Pediatric allergic rhinitis and comorbid disorders. J Allergy Clin Immunol 2001, 108:S9–S15.CrossRefPubMed
44.
45.
Flemons WW, Tsai W: Quality of life consequences of sleep-disordered breathing. J Allergy Clin Immunol 1997, 99:S750–S756.CrossRefPubMed
46.
Martin SE, Engleman HM, Deary IJ, et al.: The effect of sleep fragmentation on daytime function. Am J Respir Crit Care Med 1996, 153:1328–1332.PubMed
47.
Martin SE, Wraith PK, Deary IJ, et al.: The effect of nonvisible sleep fragmentation on daytime function. Am J Respir Crit Care Med 1997, 155:1596–1601.PubMed
48.
Juniper EF, Guyatt GH, Dolovich J: Assessment of quality of life in adolescents with allergic rhinoconjunctivitis: development and testing of a questionnaire for clinical trials. J Allergy Clin Immunol 1994, 93:413–423.CrossRefPubMed
49.
Fisher L, Ghaffari G, Davies M, et al.: Effects of poor sleep in allergic rhinitis. Curr Opin Allergy Clin Immunol 2005, 5:11–16.PubMedCrossRef
50.
Kremer B, den Hartog HM, Jolles J: Relationship between allergic rhinitis, disturbed cognitive functions and psychological well-being. Clin Exp Allergy 2002, 32:1310–1315.CrossRefPubMed
51.
Juniper EF, Stahl E, Doty RL, et al.: Clinical outcomes and adverse effect monitoring in allergic rhinitis. J Allergy Clin Immunol 2005, 115:S390–S413.CrossRefPubMed
52.
Johns MW: A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep 1991, 14:540–545.PubMed
53.
Buysse DJ, Reynolds CF 3rd, Monk TH, et al.: The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989, 28:193–213.CrossRefPubMed
54.
Flemons WW, Reimer MA: Measurement properties of the Calgary Sleep Apnea Quality of Life Index. Am J Respir Crit Care Med 2002, 165:159–164.PubMed
55.
Weaver TE, Laizner AM, Evans LK, et al.: An instrument to measure functional status outcomes for disorders of excessive sleepiness. Sleep 1997, 20:835–843.PubMed
56.
Mansfield LE, Diaz G, Posey CR, et al.: Sleep disordered breathing and daytime quality of life in children with allergic rhinitis during treatment with intranasal budesonide. Ann Allergy Asthma Immunol 2004, 92:240–244.CrossRefPubMed
57.
Craig TJ, Mende C, Hughes K, et al.: The effect of topical nasal fluticasone on objective sleep testing and the symptoms of rhinitis, sleep, and daytime somnolence in perennial allergic rhinitis. Allergy Asthma Proc 2003, 24:53–58.PubMed
58.
Murray JJ, Nathan RA, Bronsky EA, et al.: Comprehensive evaluation of cetirizine in the management of seasonal allergic rhinitis: impact on symptoms, quality of life, productivity, and activity impairment. Allergy Asthma Proc 2002, 23:391–398.PubMed
59.
Golden S, Teets SJ, Lehman EB, et al.: Effect of topical nasal azelastine on the symptoms of rhinitis, sleep, and daytime somnolence in perennial allergic rhinitis. Ann Allergy Asthma Immunol 2000, 85:53–57.CrossRefPubMed
60.
McLean HA, Urton AM, Driver HS, et al.: Effect of treating severe nasal obstruction on the severity of obstructive sleep apnea. Eur Respir J 2005, 25:521–527.CrossRefPubMed
61.
Milgrom H, Biondi R, Georgitis JW, et al.: Comparison of ipratropium bromide 0.03% with beclomethasone dipropionate in the treatment of perennial rhinitis in children. Ann Allergy Asthma Immunol 1999, 83:105–111.CrossRefPubMed
62.
Goldbart AD, Goldman JL, Veling MC, et al.: Leukotriene modifier therapy for mild sleep-disordered breathing in children. Am J Respir Crit Care Med 2005, 172:364–370.CrossRefPubMed
63.
Moinuddin R, deTineo M, Maleckar B, et al.: Comparison of the combinations of fexofenadine-pseudoephedrine and loratadine-montelukast in the treatment of seasonal allergic rhinitis. Ann Allergy Asthma Immunol 2004, 92:73–79.CrossRefPubMed
64.
Santos CB, Hanks C, McCann J, et al.: The role of montelukast on perennial allergic rhinitis and associated sleep disturbances and daytime somnolence. Allergy Asthma Proc 2008, 29:140–145.CrossRefPubMed
65.
Bousquet J, van Cauwenberge P, Khaltaev N; ARIA Workshop Group, World Health Organization: Allergic rhinitis and its impact on asthma (ARIA). J Allergy Clin Immunol 2001, 108:S147–S334.CrossRefPubMed
66.
Bende M, Carrillo T, Vóna I, et al.: A randomized comparison of the effects of budesonide and mometasone furoate aqueous nasal sprays on nasal peak flow rate and symptoms in perennial allergic rhinitis. Ann Allergy Asthma Immunol 2002, 88:617–623.CrossRefPubMed
67.
Hughes K, Glass C, Ripchinski M, et al.: Efficacy of the topical nasal steroid budesonide on improving sleep and daytime somnolence in patients with perennial allergic rhinitis. Allergy 2003, 58:380–385.CrossRefPubMed
68.
Craig TJ, Gurevich F, Glass C, et al.: The effect of intranasal steroid budesonide on sleep disturbance and daytime somnolence in patients with perennial allergic rhinitis [abstract 1227]. J Allergy Clin Immunol 2004, 113:S332.CrossRef
69.
Berlin JM, Golden SJ, Teets S, et al.: Efficacy of a steroid nasal spray compared with an antihistamine nasal spray in the treatment of perennial allergic rhinitis. J Am Osteopath Assoc 2000, 100:8–13.
70.
• Mansfield LE, Posey CR: Daytime sleepiness and cognitive performance improve in seasonal allergic rhinitis treated with intranasal fluticasone propionate. Allergy Asthma Proc 2007, 28:226–229. This article is important in that it shows the benefits of intranasal corticosteroids in patients with rhinitis and associated sleep disturbance.CrossRefPubMed
71.
Bender BG, Milgrom H: Comparison of the effects of fluticasone propionate aqueous nasal spray and loratadine on daytime alertness and performance in children with seasonal allergic rhinitis. Ann Allergy Asthma Immunol 2004, 92:344–349.CrossRefPubMed
72.
Kiely JL, Nolan P, McNicholas WT: Intranasal corticosteroid therapy for obstructive sleep apnoea in patients with co-existing rhinitis. Thorax 2004, 59:50–55.PubMed
73.
Potter PC, Van Niekerk CH, Schoeman HS: Effects of triamcinolone on quality of life in patients with persistent allergic rhinitis. Ann Allergy Asthma Immunol 2003, 91:368–374.CrossRefPubMed
74.
Mintz M, Garcia J, Diener P, et al.: Triamcinolone acetonide aqueous nasal spray improves nocturnal rhinitis-related quality of life in patients treated in a primary care setting: the Quality of Sleep in Allergic Rhinitis study. Ann Allergy Asthma Immunol 2004, 92:255–261.CrossRefPubMed
75.
•• Craig TJ, Ferguson BJ, Krouse JH: Sleep impairment in allergic rhinitis, rhinosinusitis, and nasal polyposis. Am J Otolaryngol 2008, 29:209–217. This was a well-done summary of the effects of rhinitis and rhinosinusitis on sleep and quality of life.CrossRefPubMed
Metadata
Title
Congestion and Sleep Impairment in Allergic Rhinitis
Authors
Timothy J. Craig
Amir Sherkat
Sahar Safaee
Publication date
01-03-2010
Publisher
Current Science Inc.
Published in
Current Allergy and Asthma Reports / Issue 2/2010
Print ISSN: 1529-7322
Electronic ISSN: 1534-6315
DOI
https://doi.org/10.1007/s11882-010-0091-5

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