Sleep actigraphy evidence of improved sleep after treatment of allergic rhinitis

ArticleinAnnals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 103(4):290-4 · October 2009with20 Reads
DOI: 10.1016/S1081-1206(10)60527-3 · Source: PubMed
Children with allergic rhinitis (AR) are reported to have disturbed sleep and daytime fatigue due to nasal obstruction. To evaluate sleep impairment in children with AR using actigraphic evaluation. Fourteen children aged 7 to 16 years with grass pollen-sensitized seasonal AR were enrolled. They completed the Total 4-Symptom Score (T4SS) scoring system for AR symptom score and the Pittsburgh Sleep Quality Index (PSQI) questionnaire for sleep quality, and they underwent actigraphy for 3 days in the pretreatment period. After topical corticosteroid and antihistaminic treatment for 8 weeks, actigraphy, the T4SS, and the PSQI were repeated. Fourteen healthy children aged 8 to 16 years underwent actigraphy and completed the PSQI questionnaire as controls. There were no significant age or sex differences between the AR and control groups. Pretreatment PSQI and actigraphy scores were worse in the AR group vs the control group. After treatment, sleep quality improved, and there were no differences in actigraphy and PSQI scores between the 2 groups. Before treatment, the T4SS was significantly correlated with the sleep efficiency, daytime napping episodes, and total nap duration variables of actigraphy (r = -0.53, P = .004; r = 0.43, P = .02; and r = 0.39, P = .04, respectively). The T4SS was correlated with the total PSQI score (r = 0.67, P < .001). Sleep can be compromised in children with AR. There is a significant correlation of clinical symptom score with the actigraphic and PSQI variables. Therefore, actigraphy may be used as an objective tool to evaluate sleep disturbance in children with AR.
    • "Recent investigations have confirmed that individuals with OSA have marked nasal inflammatory changes,5,6 suggesting a potential link between OSA and rhinitis. This association is also suggested by the clinical observation that patients with allergic rhinitis have poor sleep quality according to actigraphic and Pittsburgh Sleep Quality Index variables.7 Adults with rhinitis have a higher prevalence of OSA,8 and those with rhinitis and OSA have more daytime sleepiness and lower quality of life according to the Epworth sleepiness scale and the Rhinosinusitis Quality of Life Questionnaire.9 "
    [Show abstract] [Hide abstract] ABSTRACT: Rhinitis and obstructive sleep apnea (OSA) often coexist during childhood. To delineate this clinical association, we examined OSA severity and polysomnogram (PSG) features in children with rhinitis and OSA. Given that rapid-eye-movement (REM) sleep is characterized by nasal congestion, we hypothesized that children with rhinitis have more REM-related breathing abnormalities. We conducted a retrospective cross-sectional analysis of 145 children with PSG-diagnosed OSA. Outcomes included PSG parameters and obstructive apnea-hypopnea index (OAHI) during REM and non-REM. Linear multivariable models examined the joint effect of rhinitis and OSA parameters with control for potential confounders. Rhinitis was present in 43% of children with OSA (n = 63) but overall OAHI severity was unaffected by the presence of rhinitis. In contrast, OAHI during REM sleep in children with moderate-severe OSA was significantly increased in subjects with rhinitis and OSA (44.1/hr; SE = 6.4) compared with those with OSA alone (28.2/hr; SE = 3.8). Rhinitis is highly prevalent in children with OSA. Although OSA is not more severe in children with rhinitis, they do have a distinct OSA phenotype characterized by more REM-related OSA. Further research is needed to delineate the link between REM-sleep and the physiology of the nose during health and disease.
    Full-text · Article · Mar 2014
    • "Some of the physical complications of AR in children include otitis media with effusion, chronic or recurrent rhinosinusitis and coexistence of asthma [5,6]. Besides physical complications, pediatric AR is associated with disturbance of sleep, psychosocial problems, decrease in school performance due to absenteeism, learning difficulties and distraction as well as impairment in overall quality of life56789. Thus, high prevalence and significant morbidity makes AR and its treatment a topic of research interest. Unique characteristics of the pediatric age group such as differences in maturity of drug metabolic pathways, long term favorable results of early treatment before complications develop and ethical issues in carrying out clinical trials necessitate treatment recommendations different from adults. "
    [Show abstract] [Hide abstract] ABSTRACT: Allergic rhinitis (AR) is one of the most common chronic diseases of childhood and carries significant morbidity as well as physical and psychosocial consequences. Therapy aims to alleviate clinical symptoms, prevent complications and improve psychosocial consequences. Leukotrienes which are amongst the main mediators in pathogenesis of AR have chemotactic properties and lead to increased vascular permeability. Thus, leukotriene antagonism may be an effective therapeutic option in treatment of allergic diseases, specifically AR. Montelukast which is a leukotriene receptor type I inhibitor has variable efficacy in children with AR and the guidelines recommend its use in children with seasonal AR aged six years and above. Although its efficacy is inferior to anti-histamines and intranasal corticosteroids, combination treatment may warrant clinical efficacy. Therefore, montelukast may be considered to be a well-tolerated therapeutic option for children with AR with minor side effects though long term results need to be assessed. In conclusion, larger scale research enrolling pediatric cases with seasonal and persistent AR are required before concise recommendations about montelukast use in pediatric AR can be made.
    Full-text · Article · Oct 2013
    • "That was also documented by Chng [26] who discovered that there is a significant association between habitual snoring and allergic rhinitis. Also, Yuksel et al. [27] found that there is a significant inverse correlation between total nasal symptom score (TNSS) and sleep efficacy in patients with allergic rhinitis. "
    [Show abstract] [Hide abstract] ABSTRACT: Allergic rhinitis is among the most common chronic disorders of childhood with prevalence of up to 40% in children. Clara cell secretory protein (CCSP) is secreted by Clara cells in the lining fluid of airways. It has an immune-modulatory and anti-inflammatory activity. Study aimed at evaluating CCSP as a biomarker in serum and nasal lavage fluid of children with allergic rhinitis. A case-control study was conducted on sera and nasal lavage fluid samples from 15 children with allergic rhinitis and 15 healthy children as a control group. Children with allergic rhinitis had a male to female ratio 2 to 1, with a mean age of 9.47±2.75 years, while among the healthy group, six were males and nine were females, with a mean age of 8.63±2.28 years. Rhinorrhea and nasal obstruction were the most frequent symptoms (100%) followed by itching (93.3%) then sneezing (73.3%). Among allergic rhinitis patients serum CCSP mean±SD was 2.03±0.59μg/l; it was reliable to predict allergic rhinitis (P<0.0001); while nasal lavage CCSP mean±SD was 12.73±8.25μg/l and it was not reliable to predict allergic rhinitis. Its best cut-off value was 3.75μg/l with a sensitivity of 100%, specificity 80%, with a diagnostic accuracy of 90%. Clara cell secretory protein is a new peripheral sensitive marker of airway injury. Furthermore, serum CCSP level is a predictor of allergic rhinitis but not nasal lavage fluid CCSP.
    Full-text · Article · Jun 2012
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