Sleep impairment and daytime sleepiness in patients with allergic rhinitis: the role of congestion and inflammation

Objective: To investigate the association of rhinitis with stress, fatigue, decrease productivity, inflammation, and sleep disordered breathing. Data Sources: Medical literature obtained from OVID and PubMed searches in February 2013 using the search terms "sleep," "rhinitis," "allergic rhinitis," "somnolence," and "fatigue". Study Selections: Studies were selected based on the US Preventive Services Task Force levels 1, 2, and 3. Results: Allergic rhinitis is a disease that severely affects patients' quality of life and is increasing in prevalence worldwide. Nasal congestion is reported as the most common and bothersome symptom; it is often associated with sleep-disordered breathing, a likely cause of sleep impairment in rhinitis-affected individuals. The end result is a reduced quality of life and productivity and an increase in daytime sleepiness, fatigue, and stress. Current treatment modalities include intranasal corticosteroids, which have been found to reduce nasal congestion. Clinical trials on intranasal corticosteroids have provided data on sleep-related end points, and these studies report that the improved nasal congestion is associated with improved quality of life with better sleep and reduced daytime fatigue. Alternate therapies, including montelukast, also decrease nasal congestion and positively influence sleep, but to a lesser extent. Conclusion: This review examines nasal congestion and cytokine changes and the associated sleep impairment in allergic rhinitis patients and the effect on daytime performance. It elaborates the adverse effects of disturbed sleep on quality of life and how therapies directed at reducing nasal congestion can relieve such effects. (C) 2013 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.