By Christopher R. Roxbury, MD
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Allergic rhinitis, commonly referred to as “hay fever,” is a chronic atopic condition in the United States, with a prevalence of approximately 10-20 percent in adults and a slightly higher prevalence in children. Patients with allergic rhinitis typically note itchy, watery eyes, frequent sneezing, runny noses and nasal obstruction. While allergic rhinitis is not a dangerous condition, it can have a profound impact on quality of life and has been shown to be associated with decreased productivity at school or work.
Nasal obstruction may increase upper airway pressure, which is associated with sleep disturbances such as obstructive sleep apnea. While there is growing evidence to support a link between allergic rhinitis, obstructive sleep apnea and poor sleep, little is known about the association between allergic rhinitis and sleep disturbances in U.S. adults.
The National Health and Nutrition Examination Survey (NHANES) is an ongoing population-based survey conducted by the Centers for Disease Control and Prevention, with the purpose of estimating disease prevalence. NHANES uses a complex sampling design and population-weighing system that ensures that the subjects are a representative sample of the U.S. population.
A recent analysis of NHANES data performed at Cleveland Clinic in collaboration with researchers at Johns Hopkins University School of Medicine sought to further understand how allergic rhinitis might affect sleep in a representative sample of U.S. adults. For this study, patients were considered to have allergic rhinitis if they reported having an episode of “hay fever” or if they noted having problems with sneezing, runny or blocked nose when they did not have a cold or the flu in the past 12 months.
Participants in the NHANES survey were asked a series of questions about their sleep history, including how long it takes to fall asleep, how much sleep they get on a regular basis, if they have any difficulties staying asleep at night, and if they have ever been told by a doctor that they have a sleep disorder such as insomnia, restless legs syndrome, or obstructive sleep apnea. They were also asked how often they had difficulty performing daily tasks due to being too tired or sleepy.
Those participants who had experienced allergic rhinitis symptoms in the past 12 months were 43 percent more likely to report difficulty falling asleep, 49 percent more likely to report waking frequently during the night and 46 percent more likely to report waking too early in the morning. These participants were also 76 percent more likely to feel unrested during the day, 68 percent more likely to admit not getting enough sleep, and 69 percent more likely to rely on sleep medication.
Study participants with allergic rhinitis did not only report poor sleep quality, but also noted that their poor sleep frequently affected their ability to function during the day. Specifically, subjects with allergic rhinitis had 93 percent higher odds of difficulty concentrating on daily tasks, 91 percent higher odds of difficulty remembering things, and 68 percent higher odds of having difficulty managing their finances. These subjects were more than twice as likely to note difficulty performing at work and completing daytime tasks due to being excessively sleepy.
In addition to reporting poor sleep and difficulty performing daytime tasks due to sleepiness, participants with allergic rhinitis were also 85 percent more likely to have been diagnosed by a physician with insomnia. Moreover, they were 86 percent more likely to have been diagnosed with obstructive sleep apnea, a potentially life-threatening condition that can lead to cardiopulmonary failure if left untreated.
While this study revealed associations between allergic rhinitis and poor sleep quality, daytime dysfunction, insomnia and obstructive sleep apnea in U.S. adults, further studies are needed to assess the role of allergic rhinitis treatment on improving sleep and mitigating the effects of obstructive sleep apnea. These results reinforce the need to assess sleep quality in patients diagnosed with allergic rhinitis.
Figure 1. Association between allergic rhinitis and sleep parameters, when adjusting for age, gender, race and obesity.
Dr. Roxbury is clinical staff in the Head & Neck Institute, Section of Rhinology, Sinus & Skull Base Surgery and Section of General/Regional Otolaryngology. His clinical and research interests include inflammatory and neoplastic conditions of the nose, paranasal sinuses and anterior cranial base. He sees adult and pediatric patients with both rhinologic and general otolaryngologic concerns. He can be reached at firstname.lastname@example.org.