title: The association between allergic rhinitis and sleep-disordered breathing in children: a systematic review.
abstract: BACKGROUND
  The objective of this work was to systematically review existing literature on the association between allergic rhinitis (AR) and sleep-disordered breathing (SDB) in children.
  
  
  METHODS
  We performed a literature search encompassing the last 25 years in PubMed, EMBASE, and Cochrane CENTRAL. Inclusion criteria included English-language papers containing original human data, number of subjects ≥7, and age <18 years old. Data was systematically collected on study design, patient demographics, clinical characteristics/outcomes, and level-of-evidence. Two investigators independently reviewed all articles.
  
  
  RESULTS
  The initial search yielded 433 abstracts, of which 18 articles were included. Twelve (67%) of the 18 articles showed a statistically significant association between AR and SDB. All articles were either case-series or case-control studies. Based on the Newcastle-Ottawa scale, the quality of the articles was determined to be fair to good. For characterizing AR, 7 (39%) studies included skin-prick testing and/or in vitro testing. For determining presence of SDB, 7 (39%) of the studies used polysomnographic data, of which 1 study incorporated data from a home polysomnogram. Habitual snoring was the most common form of SDB studied, in 10 (56%) of the articles. Obstructive sleep apnea was studied in 6 (33%) articles.
  
  
  CONCLUSIONS
  Although the majority of the studies included in this review showed a significant association between AR and SDB, all of the studies were evidence level 3b and 4, for an overall grade of B- evidence (Oxford Evidence-Based Medicine Center). Further higher-quality studies should be performed in the future to better evaluate the relationship between AR and SDB in children.
authors: Johns Hopkins Department of Otolaryngology-Head and Neck Surgery, Baltimore, MD 21287, USA. slin@jhmi.edu
authors: Sandra Y
authors: SY
authors: Lin
authors: Thuy-Anh N
authors: TA
authors: Melvin
authors: Emily F
authors: EF
authors: Boss
authors: Stacey L
authors: SL
authors: Ishman
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D019317:Evidence-Based Medicine; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017286:Polysomnography / Q000379:methods; D065631:Rhinitis, Allergic; D012221:Rhinitis, Allergic, Perennial / Q000150:complications*; D012891:Sleep Apnea Syndromes / Q000150:complications*; D020181:Sleep Apnea, Obstructive / Q000150:complications; D012913:Snoring / Q000150:complications