Clinical associations between allergies and rapid eye movement sleep disturbances

Abstract

BackgroundAllergic rhinitis, an immunoglobulin E inflammatory condition including nasal congestion, obstruction, sneezing, pruritus, and fatigue symptoms, has significant impact on quality of life and impairs sleep. Sleep‐disordered breathing (SDB) patients often have normal all‐night apnea‐hypopnea (AHI) or respiratory‐disturbance (RDI) indices on polysomnography (PSG). We hypothesized that the rapid eye motion–respiratory disturbance index (REM‐RDI) may be a novel predictor of allergic status.MethodsA retrospective analysis of 100 patients compared REM‐RDI results in 67 allergen‐positive patients with 33 nonallergic patients who presented with nasal blockage. Subjects completed STOP‐Bang©, 22‐item Sino‐Nasal Outcome Test (SNOT‐22)©, and Epworth Sleepiness Scale© questionnaires and underwent skin‐prick testing (SPT) and PSGs including REM‐RDI values. Using multivariate logistic regression models, we evaluated relationships between allergic status and sleep parameters while controlling for possible confounders including body mass index (BMI).ResultsUsing REM‐RDI as the outcome of interest, allergen‐positive patients were 3.92 times more likely to have REM‐RDI values in a moderate/severe range (≥15 events/hour); and patients with moderate/severe REM‐RDI values were more likely to be allergen positive (p < 0.05). Allergic status was not significantly related to all‐night AHI, RDI, or REM‐AHI. BMI was not significantly related to REM‐RDI. STOP‐Bang© was related to allergy status (p = 0.02) and REM‐RDI (p < 0.01). Allergic patients had increased REM latency and less total amount of REM.ConclusionWe revealed significant bidirectional associations between allergen positivity and increased REM‐RDI values independent of BMI, AHI, RDI, and REM‐AHI. Allergic inflammation and REM‐RDI data may play important roles in diagnosing and treating fatigued SDB patients and as objective perioperative safety and outcomes measures.

Severity of allergic rhinitis impacts sleep and anxiety: results from a large Spanish cohort

“…Sleep impairment has subsequent effects on daytime performance and HRQL. Moreover, the inflammatory cytokines released during allergic reactions have been related to the suppression of both rapid eyes movement (REM) and no‐REM phase [13, 14 ].…”

International consensus statement on allergy and rhinology: Allergic rhinitis – 2023

“…Further, in children, SDB may negatively impact brain development, impair psychomotor, and cognitive performance, and contribute to hyperactivity 3338–3340 . REM sleep is associated with memory, cognition, dreams, and restorative sleep 1119,1147 . As the nasal cycle is prolonged, worsening nasal obstruction, people with AR have impaired REM sleep 1119,1147,3341–3343 .…”

“…The data on PSG parameters in adults is mixed. Most studies that perform PSG found that AR worsens PSG parameters 1103,1113–1122 ; however, two studies found either no difference or a modest change 1123,1124 …”

Recognizing Poor Sleep Quality Factors During Oral Health Evaluations

“…5,6 Obstructive Sleep Apnea Airway collapses during the sleep cycle, preventing normal breathing, causing lack of oxygen to the brain, preventing the individual from reaching deep sleep along with body and brain repair. 1,5,6,13,14 Poor memory processing, poor emotion processing [2][3][4][5][6]9,12,37 out of the deep stages of sleep, they are prevented from obtaining rejuvenation of the body and brain needed to achieve or maintain optimal health. 1,2 Sleep arousals can be caused by poor sleep hygiene, restricted airway, systemic health issues, or cognitive health issues.…”