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. Author manuscript; available in PMC: 2020 Jun 10.
Published in final edited form as: Int Forum Allergy Rhinol. 2018 Feb;8(2):108–352. doi: 10.1002/alr.22073

TABLE VII.A.2-1.

Effect of allergic rhinitis on sleep in adults

Study Year LOE Study design Study groups Clinical endpoint Conclusion
Shanqun et al.709 2009 1b RCT AR and OSA (n = 89):

  1. Montelukast + budesonide (n = 44);

  2. Placebo (n = 45)

 ESS, RQLQ, TSS, CSAQLI, symptoms diary Montelukast + budesonide improves AR and OSA QOL, sleep quality, and daytime somnolence.
Mansfield & Posey708 2007 1b RCT

  1. Fluticasone (n = 16);

  2. Placebo (n = 16)

 TOVA, ESS, TSS Fluticasone improves daytime sleepiness, cognitive performance, and nasal symptoms.
Gurevich et al.705 2005 1b RCT, crossover PAR (n = 26), nasal budesonide ESS, sleep diary, questionnaire Budesonide reduces nasal congestion, daytime somnolence/fatigue, and improves sleep quality in PAR.
Hughes et al.706 2003 1b RCT, crossover PAR (n = 22), nasal budesonide vs placebo ESS, FOSQ, RQLQ, symptom diary Budesonide improves daytime fatigue and sleep quality in PAR.
Craig et al.707 1998 1b RCT, crossover AR (n = 20), flunisolide vs placebo Symptom and sleep diary Nasal corticosteroids improve symptoms and subjective sleep compared to controls.
Parikh et al.715 2014 2b Observational cohort OSA and rhinitis (n = 43) ESS, symptoms scores, CPAP compliance Control of rhinitis (with varying regimens of steroid sprays, antihistamines, leukotrienes inhibitors, anticholinergics, etc.) important for OSA control. No difference: AR vs NAR.
Acar et al.716 2013 2b Observational cohort OSA and AR (n = 80) ESS, PSG Nasal corticosteroids improve sleep quality and AR symptoms. Addition of antihistamine did not have effect.
Lavigne et al.717 2013 2b Observational cross-sectional

  1. OSA and AR (n = 34);

  2. OSA without rhinitis (n = 21)

 PSG, nasal biopsies In AR, nasal corticosteroids reduce nasal inflammation and improve PSG parameters.
Udaka et al.723 2007 2b Observational cross-sectional Daytime workers (n = 3442) Questionnaire, ESS, SF-36 Severity of nasal obstruction (nonvalidated questionnaire) correlates with worse ESS and lower QOL.
Mintz et al.724 2004 2b Individual cohort AR (n = 651) Nocturnal RQLQ, PSQI Treatment with triamcinolone improves nocturnal rhinitis QOL and sleep quality.
Camhi et al.713 2000 2b Case-control n = 437 from TESOAD with sleep problems/snoring Questionnaire AR is a risk factor for snoring.
Janson et al.725 1996 2b Observational cross-sectional n = 2661 random population of the ECRHS SPT, methacholine challenge, questionnaire AR independently associated with difficulty initiating sleep and daytime sleepiness (OR 2.0).
Colas et al.726 2012 2c Population-based AR (n = 2275) TSS, RQLQ, PSQI AR disease severity has strong relationship with sleep disturbance.
Leger et al.727 2006 2c Population-based AR (n = 591) SDQ, ESS, symptom score All dimensions of sleep impaired by AR, disease severity correlated with degree of sleep impairment.
Young et al.714 1997 2c Population-based Survey subjects (n = 4297); objective testing subjects (n = 911) Questionnaire, PSG AR and nasal obstruction associated with snoring, daytime sleepiness, and SDB.
Bozkurt et al.721 2017 3b Case-control

  1. PAR and OSA symptoms (n = 150);

  2. Controls (n = 95)

 SPT, PSG PAR did not affect PSG findings compared to controls.
Gadi et al.728 2017 3b Observational cross-sectional Sleep clinic patients (n = 157) History, laboratory testing 62% OSA; 53% AR in OSA. No difference in AR/atopy between OSA and non-OSA cohorts.
Park et al.729 2012 3b Observational cross-sectional

  1. OSA and AR (n = 37);

  2. OSA without rhinitis (n = 75)

 ESS, stress score, fatigue score, coping score, RQLQ AR in OSA increases stress and fatigue, worsens sleepiness and QOL.
Meng et al.720 2011 3b Case-control

  1. PAR (n = 98);

  2. Controls (n = 30)

 PSG PSG parameters showed modest changes in PAR patients.
Rimmer et al.711 2009 3b Observational cohort

  1. PAR (n = 10);

  2. Control (n = 10)

 Actigraphy AR has increased sleep fragmentation and reduced sleep quality.
Canova et al.730 2004 3b Case-control

  1. OSA (n = 72);

  2. COPD controls (n = 44)

 Symptom score, spirometry, SPT OSA more likely to be sensitized to perennial allergens (11% in OSA vs 2.3% COPD).
Stuck et al.731 2004 3b Observational cohort

  1. SAR (n = 25);

  2. Controls (n = 25)

 ESS, SF-36, PSG SAR leads to increased daytime sleepiness compared to controls.
Krouse et al.719 2002 3b Exploratory cohort

  1. AR (n = 4);

  2. Controls (n = 4)

 PSG, serum and nasal cytokines Differing cytokine levels associated with variations in PSG.
Lavie et al.712 1981 3b Observational cohort

  1. AR (n = 14);

  2. Controls (n = 7)

 PSG AR patients had 10-fold increase in microarousals compared to controls.
McNicholas et al.718 1982 4 Case series AR (n = 7) Nasal resistance, PSG AR patients have worse OSA symptoms when symptoms are present and have high nasal resistance.

AR = allergic rhinitis; COPD = chronic obstructive pulmonary disease; CPAP = continuous positive airway pressure; CSAQLI = Calgary Sleep Apnea Quality of Life Index; ESS = Epworth Sleepiness Scale; FOSQ = Functional Outcomes of Sleep Questionnaire; LOE = level of evidence; NAR = non-allergic rhinitis; OR = odds ratio; OSA = obstructive sleep apnea; PAR = perennial allergic rhinitis; PSG = polysomnogram; PSQI = Pittsburgh Sleep Quality Index; QOL = quality of life; RCT = randomized controlled trial; RQLQ = Rhinoconjunctivitis Quality of Life Questionnaire; SAR = seasonal allergic rhinitis; SDB = sleep disordered breathing; ECRHS = European Community Respiratory Health Survey; SDQ = Sleep Disorders Questionnaire; SF-36 = Short Form 36; SPT = skin-prick test; TESOAD = Tucson Epidemiology Study of Obstructive Airway Disease; TOVA = Test of Variables Attention; TSS = total symptom score.