Nasal congestion secondary to allergic rhinitis as a cause of sleep disturbance and daytime fatigue and the response to topical nasal corticosteroids.
BACKGROUND
Allergic rhinitis (AR) is a frequent disease affecting up to 20% of the population. AR causes a hypersensitivity reaction, which results in inflamed nasal mucosa and nasal congestion. Negative pressure generated during inspiration in the nasal airway secondary to nasal congestion may lead to nasal collapse, airway obstruction, and an increased number of sleep microarousals. Sleep disturbances and microarousals can detrimentally affect daytime energy levels, mood, and daytime function. It is unknown whether treatment directed to reduce congestion may reduce these microarousals, sleep problems, and, consequently, associated daytime fatigue.


OBJECTIVE
We sought to determine whether reducing nasal congestion with nasal steroids will reduce sleep complaints and daytime sleepiness.


METHODS
We enrolled 20 subjects in a double-blind, placebo-controlled study using Balaam's Design. Patients were treated with topical nasal corticosteroids or placebo. Subjective data were collected by use of a daily diary, which focused on nasal symptoms, sleep, and daytime sleepiness.


RESULTS
The results demonstrated that nasal congestion and subjective sleep improved significantly in the topical corticosteroid-treated subjects but not in the placebo group. Sleepiness improved, but not significantly (p = 0.08).


CONCLUSIONS
Often, people with perennial allergies may attribute their daytime fatigue to causes such as the side effects of medications, when in fact, the fatigue may be a result of nasal congestion and associated sleep fragmentation. Decreasing nasal congestion with nasal steroids may improve sleep, daytime fatigue, and the quality of life of patients with AR.
Craig
T J
TJ
Allergy Clinic, Division of Medicine, Penn State University, Hershey, USA.
Teets
S
S
Lehman
E B
EB
Chinchilli
V M
VM
Zwillich
C
C
D000287:Administration, Topical; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D018926:Anti-Allergic Agents / Q000627:therapeutic use*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005221:Fatigue / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D015508:Nasal Obstruction / Q000188:drug therapy*; D012221:Rhinitis, Allergic, Perennial / Q000188:drug therapy*; D012891:Sleep Apnea Syndromes / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D018926:Anti-Allergic Agents