Nasal congestion secondary to allergic rhinitis as a cause of sleep disturbance and daytime fatigue and the response to topical nasal corticosteroids,☆☆,,★★

https://doi.org/10.1016/S0091-6749(98)70171-XGet rights and content

Abstract

Background: Allergic rhinitis (AR) is a frequent disease affecting up to 20% of the population. AR causes a hypersensitivity reaction, which results in inflamed nasal mucosa and nasal congestion. Negative pressure generated during inspiration in the nasal airway secondary to nasal congestion may lead to nasal collapse, airway obstruction, and an increased number of sleep microarousals. Sleep disturbances and microarousals can detrimentally affect daytime energy levels, mood, and daytime function. It is unknown whether treatment directed to reduce congestion may reduce these microarousals, sleep problems, and, consequently, associated daytime fatigue. Objective: We sought to determine whether reducing nasal congestion with nasal steroids will reduce sleep complaints and daytime sleepiness. Method: We enrolled 20 subjects in a double-blind, placebo-controlled study using Balaam's Design. Patients were treated with topical nasal corticosteroids or placebo. Subjective data were collected by use of a daily diary, which focused on nasal symptoms, sleep, and daytime sleepiness. Results: The results demonstrated that nasal congestion and subjective sleep improved significantly in the topical corticosteroid–treated subjects but not in the placebo group. Sleepiness improved, but not significantly (p = 0.08). Conclusion: Often, people with perennial allergies may attribute their daytime fatigue to causes such as the side effects of medications, when in fact, the fatigue may be a result of nasal congestion and associated sleep fragmentation. Decreasing nasal congestion with nasal steroids may improve sleep, daytime fatigue, and the quality of life of patients with AR. (J Allergy Clin Immunol 1998;101:633-7.)

Section snippets

Methods

The investigation was designed as a double-blind, placebo-controlled, crossover study and incorporated Balaam's design, which uses the sequences AP (active-placebo), PA (placebo-active), AA (active-active), and PP (placebo-placebo). In a crossover design each subject serves as his or her own control. Therefore the estimated treatment differences tend to have less variability than that observed in a parallel design. Smaller variability leads to a smaller sample size. Also, the

Results

Nineteen of the 20 patients who entered the study completed the protocol. Two patients who were randomized to active therapy first and later crossed over to placebo were unable to continue receiving the placebo because of the severity of their symptoms. One patient left the study, and the other was continued but switched to open-label therapy. The latter patient's data were analyzed in the group to which he was randomized (placebo) because the blind was not removed until completion of the

Discussion

Allergic rhinitis is the most common allergic disease in the United States, with an incidence of approximately 15% to 20% in North America.18 Allergic rhinitis is characterized by an IgE-mediated nasal response to allergens resulting in activation of mast cells, release of chemical mediators, and the influx of inflammatory cells, especially eosinophils. It is this inflammation that gives rise to the congestion that frequently complicates perennial AR. Somewhere between 40% and 65% of patients

Acknowledgements

We thank Angela Hamilton for her assistance in preparation of this manuscript.

References (34)

  • T Young et al.

    Nasal obstruction as a risk factor for sleep-disordered breathing

    J Allergy Clin Immunol

    (1997)
  • MH. Bonnet

    Infrequent periodic sleep disruption: effects on sleep, performance, and mood

    Physiol Behav

    (1989)
  • EF Juniper et al.

    Aqueous beclomethasone diproprionate nasal spray: regular versus as required use in the treatment of seasonal allergic rhinitis

    J Allergy Clin Immunol

    (1990)
  • P Lavie et al.

    Breathing disorders in sleep associated with microarousals in patients with allergic rhinitis

    Acta Otolaryngol

    (1981)
  • A Leznoff et al.

    Reversible obstructive sleep apnea caused by occupational exposure to guam gum dust

    Am Rev Respir Dis

    (1986)
  • J van Bavel et al.

    Intranasal fluticasone propionate is more effective than terfenadine tablets for seasonal allergic rhinitis

    Arch Intern Med

    (1994)
  • W Storms et al.

    Once daily triamcinolone acetonide nasal spray is effective for treatment of perennial allergic rhinitis

    Ann Allergy

    (1991)
  • Cited by (265)

    • Allergic Rhinitis and Its Effect on Sleep

      2024, Otolaryngologic Clinics of North America
    • Evaluation and Management of Snoring

      2022, Sleep Medicine Clinics
    • Bedroom environment and sleep health

      2022, Foundations of Sleep Health
    • The Nose and Nasal Breathing in Sleep Apnea

      2020, Otolaryngologic Clinics of North America
    • Nasal Obstruction Considerations in Sleep Apnea

      2018, Otolaryngologic Clinics of North America
    View all citing articles on Scopus

    From athe Allergy Clinic, Division of Medicine, Section of Pulmonary, Allergy, and Critical Care; bthe College of Medicine; and cthe Department of Health Evaluation Sciences, Penn State University, Hershey; and dMedical Services, Denver Veterans Affairs Medical Center, Denver.

    ☆☆

    Supported by the Pulmonary Research Fund at Penn State University.

    Reprint requests: Timothy Craig, DO, Department of Medicine, Section Pulmonary, Allergy, Critical Care, 500 University Drive, Hershey, PA 17033.

    ★★

    1/1/89253

    View full text