TABLE VII.G. 1.

Allergic rhinitis and OSA

Study	Year	LOE	Study design	Study groups	Clinical endpoint	Conclusions
Young et al.893	1997	1b	Prospective population-based cohort study	Population-based sample of individuals (n = 911, response rate 50%) enrolled in Wisconsin Sleep Cohort Study	Relationship between nasal obstruction and sleep-disordered breathing assessed via polysomnography, rhinometry, and questionnaires	Participants with nighttime symptoms of rhinitis (5+ nights/month) were significantly more likely to report habitual snoring (3–7 nights/week), chronic excessive daytime sleepiness, or nonrestorative sleep than those who rarely had symptoms (p < 0.0001). Those with nasal congestion due to allergy were 1.8× more likely to have moderate to severe sleep-disordered breathing.
Craig et al.891	2005	1a	Pooled data from three double-blind crossover RCT	69 patients with allergic rhinitis without OSA	Effect of intranasal corticosteroids in patients with perennial rhinitis on reduction of congestion and daytime somnolence	Pooled data of budesonide, flunisolide, and fluticasone demonstrated significantly decreased nasal congestion and sleepiness in treated patients. A correlation between reduction in nasal congestion and an improvement in sleep (p < 0.01) and daytime somnolence (p = 0.01) was demonstrated.
Stuck et al.892	2004	1b	Prospective, cohort study	25 patients with seasonal allergic rhinitis and 25 healthy volunteers assessed with questionnaires (ESS, SF-36) and polysomnography performed before and during pollen season	Effect of seasonal allergic rhinitis on subjective and objective sleep patterns	Seasonal allergic rhinitis leads to increased daytime sleepiness (p = 0.006) and quality of life impairment (p < 0.0001).
Santos et al.896	2008	1b	Double blind crossover RCT	31 patients with persistent allergic rhinitis and sleep disturbances treated with montelukast or placebo	Effect of rhinitis therapy on patient-reported sleep quality and symptoms of daytime sleepiness	Montelukast treatment demonstrated significant improvement in reported daytime somnolence (p = 0.0089) and daytime fatigue (p = 0.0087).
Golden et al.897	2010	1b	Double blind crossover RCT	24 patients with perennial AR received azelastine vs. saline	Effect of topical nasal antihistamines on symptoms of rhinitis, sleep, and daytime somnolence	Azelastine reduced rhinorrhea (p = 0.03) and improved subjective sleep quality (p = 0.04) but did not reduce daytime somnolence.
Lavigne et al.894	2013	2b	Prospective cohort study	21 patients with OSA and allergic rhinitis and 34 patients with OSA without allergic rhinitis	Effect of corticosteroid treatment on disease severity with sleep studies and biopsies obtained from the inferior turbinate, nasopharynx, and uvula	Improved O2 nadir, supine AHI, and daytime somnolence in AR group (p = 0.05).
Kiely et al.895	2004	1b	RCT	OSA with AHI > 10 (n = 13) vs. patients without OSA. Intervention: fluticasone spray for 4 weeks	AHI, ESS, snoring	Reduction in AHI in patients with OSA and AR compared to placebo (23.3 vs. 30.3). Most patients continued to have significant OSA.