Allergic rhinitis associated with impaired sleep quality

Patients with allergic rhinitis, such as that caused by hay fever and other allergies, have more difficulty sleeping and more sleep disorders than those without allergies, according to a report in the September 18 issue of Archives of Internal Medicine, a theme issue on sleep.

Allergic rhinitis, which occurs when pollen or other allergens irritate and inflame the nasal passages, affects about 20 to 50 percent of the population, according to background information in the article. Allergies have been shown to affect quality of life and several studies have suggested that they may contribute to snoring and breathing problems during sleep, including sleep apnea, a temporary halt to breathing. However, few researchers have closely examined sleep disorders in patients with allergic rhinitis.

Damien Léger, M.D., of Assistance Publique Hôpitaux de Paris, and colleagues explored the association between allergic rhinitis and sleep in 591 patients (47 percent men, 53 percent women, average age 34) who had the condition for at least one year and who were being treated by an allergist or by an ear, nose and throat specialist. A control group of 502 individuals who were the same age and sex and lived in the same area, but did not have allergic rhinitis, was also assessed. In 2002, all participants reported sleep disorders and rated their sleepiness; they also provided details regarding demographics, socioeconomic status and smoking habits. For patients with allergic rhinitis, researchers recorded the type of allergies, the duration of the condition, symptoms experienced and treatments used, as well as the presence and treatment of any additional allergic disorders.

All sleep disorders and complaints--including insomnia, waking up during the night, snoring and feeling fatigued when awakening--were more common in those with allergic rhinitis, who also slept fewer hours, took longer to fall asleep and more often felt sleepy during the day. Among the 591 patients with allergic rhinitis, 41.6 percent (vs. 18.3 percent of those without allergic rhinitis) reported difficulty falling asleep, 63.2 percent said they felt they lacked adequate sleep (compared with 25.4 percent of controls) and 35.8 percent (vs. 16 percent of controls) reported insomnia. "The results show a significant impact of allergic rhinitis on all dimensions of sleep quality and, consequently, a lower quality of life as reflected by more somnolence [sleepiness]; daytime fatigue and sleepiness; and impaired memory, mood and sexuality, with a significantly increased consumption of alcohol and sedatives in cases compared with the control group," the authors write.

The effects of allergic rhinitis on sleep became more pronounced when the condition was moderate to severe. As allergies worsened, individuals slept fewer hours at night, felt sleepy more often during the day, took longer to fall asleep and found it more necessary to take sedative drugs.

All types of physicians, including primary care physicians, pulmonologists and ear, nose and throat specialists, should question patients with allergic rhinitis about their sleep habits and difficulties, the authors conclude. "This could lead to early detection and treatment of sleep disorders in these patients," they write. "Treating allergic rhinitis or other nasal symptoms may improve dramatically the quality of sleep. In the long term, such a strategy would have positive repercussions on a societal level; for example, the numbers of road and work accidents would be reduced. Considering the high incidence of allergic rhinitis and the high rate of associated sleep disorders, the issue is one of public health."

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(Arch Intern Med. 2006;166:1744-1748. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: This study was supported by the Department of Epidemiology, GlaxoSmithKline Laboratory. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org.


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