Allergic and Non-Allergic Rhinitis Are Common in Obstructive Sleep Apnea but Not Associated With Disease Severity

Zheng, Ming; Wang, Xiangdong; Ge, Siqi; Gu, Ying; Ding, Xiaoqing; Zhang, Yuhuan; Ye, Jingying; Luo, Zun-Chang

doi:10.5664/jcsm.6694

Cited by 40 publications

(34 citation statements)

References 46 publications

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“…By omitting one study each time using a random effects model, sensitivity analysis was conducted for meta-analyses of sleep duration, ESS score, AHI assessed by PSG, sleep efficiency assessed by PSG, the percentage of sleep stage REM assessed by PSG, nocturnal enuresis, restless sleep, OSA, snoring, and daytime sleepiness. Pooled results of sleep duration and AHI assessed by PSG were significantly sensitive to the study of Zheng et al [30], because the direction of the synthesized MD changed after it was omitted. The results of the ESS score, sleep efficiency evaluated by PSG, nocturnal enuresis, restless sleep, and daytime sleepiness also showed instability.…”

Section: Assessment Of Study Quality and Sensitivity Analysismentioning

confidence: 89%

“…AR has been found to be positively associated with sleep-disordered breathing (SDB) [20], obstructive sleep apnea (OSA) [21], shorter sleep duration [22], poor sleep quality [23], sleep bruxism [24], night sweating [25], nocturnal enuresis [26], and daytime dysfunction [27]. However, these results are also controversial, since several studies found a negative or insignificant relationship between AR and the above sleep-related outcomes [7,[28][29][30]. Currently, there is a lack of systematic reviews to evaluate the association between AR and sleep pattern through meta-analysis.…”

Section: Introductionmentioning

confidence: 99%

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The association between allergic rhinitis and sleep: A systematic review and meta-analysis of observational studies

et al. 2020

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This systematic review and meta-analysis examines the associations of allergic rhinitis with sleep duration and sleep impairment. Observational studies published before August 2019 were obtained through English language literature searches in the PubMed, Embase, and CINAHL databases. Mean differences and odds ratios with 95% confidence intervals were extracted and used for meta-analysis. Heterogeneity was confirmed by the I 2-heterogeneity test. Subgroup analysis was conducted to evaluate the influence of study design. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to determine the level of evidence. In total, 2544 records were identified through database searches; 914 duplicate records were excluded, 1452 records were removed after screening of titles and abstracts, 151 records were excluded after full-text screening, and 27 articles were included in the final meta-analyses. A total of 240,706,026 patients (19,444,043 with allergic rhinitis) were considered. No significant difference in sleep duration between the allergic rhinitis and the control groups was found. Patients with allergic rhinitis presented with significantly higher sleep quality scores, sleep disturbances scores, and sleep latency scores; more frequent use of sleep medications; and lower sleep efficiency as measured by the Pittsburgh Sleep Quality Index and polysomnography. Meta-analyses for adjusted odds ratios showed that allergic rhinitis was also associated with higher risks of nocturnal dysfunctions, including insomnia, nocturnal enuresis, restless sleep, sleep-disordered breathing, obstructive sleep apnea, and snoring. Meta-analysis for adjusted odds ratio also showed that allergic rhinitis was associated with daytime dysfunction, including difficulty waking up, daytime sleepiness, morning headache, and the use of sleep medications. The overall quality of evidence ranged from low to very low, indicating that caution is required when interpreting these results. This study demonstrates that there is a significant association of AR with sleep characteristics.

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Section: Assessment Of Study Quality and Sensitivity Analysismentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

The association between allergic rhinitis and sleep: A systematic review and meta-analysis of observational studies

et al. 2020

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“…Some observational studies have shown how the nasal congestion induced by AR is an important factor in sleep impairment 121630 . One large population-based study involving about 5,000 adults demonstrated that individuals reporting frequent nasal congestion (5 nights/month) due to allergy were almost twice as likely to have moderate-to-severe SDB than individuals without nasal congestion due to allergy 15 .…”

Section: Discussionmentioning

confidence: 99%

“…The mechanism through which AR causes poor quality of sleep and daytime fatigue is not entirely clear, but several factors are believed to be involved. Inflammatory mediators such as interferon- (IFN-) gamma, tumour necrosis factor- (TNF-) alpha, interleukin- (IL-) 1b, IL-4, IL-10, postural changes and certain therapeutic agents, such as antihistamines, may have a direct impact on sleep regulation 121316 .…”

Section: Discussionmentioning

confidence: 99%

Nasal pathologies in patients with obstructive sleep apnoea

Magliulo

Iannella

Ciofalo

et al. 2019

Acta Otorhinolaryngol Ital

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SUMMARYNasal obstruction is a frequent condition in patients with obstructive sleep apnoea (OSA). Nasal obstruction leads to mouth breathing, which is thought to destabilise the upper airway and aggravate the condition. Three conditions could be considered as the cause of the nasal breathing obstruction: anatomical conditions of the nose (septum deviation, hypertrophy of the inferior turbinates), chronic rhinosinusitis (CRS) and chronic nasal inflammation caused by allergic rhinitis or non-allergic cellular rhinitis. In this prospective study, we present an evaluation of all these possible rhino-sinusal aspects in OSA patients to correlate different nasal pathologies with nasal obstruction. Fifty patients with a diagnosis of OSA were enrolled in the study. In 70% of OSA patients, nasal obstruction was confirmed by clinical evaluation and rhinomanometry testing. Normal rhino-sinus aspects were present in only 20% of OSA patients, whereas one or more pathological rhino-sinus conditions were present in the remaining 80%. The percentage of OSA patients with a diagnosis of allergic rhinitis and non-allergic rhinitis was 18% and 26% respectively. Non-allergic rhinitis with neutrophils (NARNE) was the most frequent type of cellular rhinitis diagnosed in OSA patients (20% of cases). The results of the present study support and extend the observation that rhinitis is present in OSA patients. Mucosal inflammation caused by these conditions could be the cause of upper airway patency impairment inducing nasal mucosa swelling.

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“…Sleep duration and insomnia may be additional factors affecting the relationship of OSA to sleepiness [6,9]. There is also increasing evidence that medical conditions that often coexist with OSA, such as CRS, anxiety, depression, PTSD and GERD, are associated with sleep complaints [11,12,13,14,15,16,17] and may confound the relationship between OSA and sleep-related quality of life outcomes. The independent contribution of each of these conditions to sleep-related complaints and the associated quality of life has not been closely examined.…”

Section: Introductionmentioning

confidence: 99%

The Association between Health Conditions in World Trade Center Responders and Sleep-Related Quality of Life and Sleep Complaints

Ayappa

Chen

Bagchi

et al. 2019

IJERPH

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Background: World Trade Center (WTC) dust-exposed subjects have multiple comorbidities that affect sleep. These include obstructive sleep apnea (OSA), chronic rhinosinusitis (CRS), gastroesophageal-reflux disorder (GERD) and post-traumatic stress disorder (PTSD). We examined the impact of these conditions to sleep-related outcomes. Methods: Demographics, co-morbidities and symptoms were obtained from 626 WTC (109F/517M), 33–87years, BMI = 29.96 ± 5.53 kg/m2) subjects. OSA diagnosis was from a 2-night home sleep test (ARESTM). Subjective sleep quality, sleep-related quality of life (QOL, Functional Outcomes of Sleep Questionnaire), excessive daytime sleepiness (Epworth Sleepiness Scale), sleep duration and sleep onset and maintenance complaints were assessed. Results: Poor sleep quality and complaints were reported by 19–70% of subjects and average sleep duration was 6.4 h. 74.8% of subjects had OSA. OSA diagnosis/severity was not associated with any sleep-related outcomes. Sleep duration was lower in subjects with all conditions (p < 0.05) except OSA. CRS was a significant risk factor for poor sleep-related QOL, sleepiness, sleep quality and insomnia; PTSD for poor sleep-related QOL and insomnia; GERD for poor sleep quality. These associations remained significant after adjustment for, age, BMI, gender, sleep duration and other comorbidities. Conclusions: Sleep complaints are common and related to several health conditions seen in WTC responders. Initial interventions in symptomatic patients with both OSA and comorbid conditions may need to be directed at sleep duration, insomnia or the comorbid condition itself, in combination with intervention for OSA.

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Allergic and Non-Allergic Rhinitis Are Common in Obstructive Sleep Apnea but Not Associated With Disease Severity

Abstract: This study suggests that despite a comparatively high prevalence in patients with OSA, the presence or severity of AR or NAR does not influence the severity of OSA; however, rhinitis may significantly disturb sleep in patients with OSA.

Cited by 40 publications

References 46 publications

The association between allergic rhinitis and sleep: A systematic review and meta-analysis of observational studies

The association between allergic rhinitis and sleep: A systematic review and meta-analysis of observational studies

Nasal pathologies in patients with obstructive sleep apnoea

The Association between Health Conditions in World Trade Center Responders and Sleep-Related Quality of Life and Sleep Complaints

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