Nasal congestion secondary to allergic rhinitis as a cause of sleep disturbance and daytime fatigue and the response to topical nasal corticosteroids
Open accessAbstract
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.Method 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).Conclusion 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.
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All five randomized controlled trials demonstrated improvement in sleep quality and sleep-related quality-of-life metrics.
“The results of all 5 studies demonstrated an improvement in sleep quality and sleep-related QOL metrics.”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [707]
The Results report significantly fewer sleep problems and improved sleep ratings with active treatment in this single randomized crossover study. The Methods describe one 20-patient study, not five trials, and the reported outcomes do not establish improvement in sleep-related quality-of-life metrics. (LLM, conf=0.88)
Experimental — accuracy not yet measuredFor the adult population, there is level 1b evidence supporting the conclusion that allergic rhinitis negatively impacts sleep.
“For the adult population, there is level 1b evidence supporting the conclusion that AR negatively impacts sleep.705-709”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [707]
Nasal obstruction due to allergic rhinitis is well established as a cause of sleep disruption.
“Nasal obstruction due to AR has been well established as a cause of sleep disruption.707,714,2026”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [707]
Five randomized controlled trials assessed the efficacy of intranasal corticosteroids on nasal congestion and sleep.
“There have been 5 RCTs assessing the efficacy of INCSs on nasal congestion and sleep.673,706,707,1275,1276”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [707]
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Cites
Linear and Nonlinear Models for the Analysis of Repeated Measurements
Vonesh, E. F., & Chinchilli, V. M. (1996) · CRC Press eBooks · doi:10.1201/9781482293272 · Cited by 994 · see citing works
Self-citationNasal obstruction as a risk factor for sleep-disordered breathing
Young, T., Finn, L., & Kim, H. (1997) · Journal of Allergy and Clinical Immunology · doi:10.1016/s0091-6749(97)70124-6 · Cited by 505 · see citing works
Sleep Fragmentation and Daytime Sleepiness
Stepanski, E. J., Lamphere, J. K., Badia, P., Zorick, F. J., & Roth, T. G. (1984) · SLEEP · doi:10.1093/sleep/7.1.18 · Cited by 347 · see citing works
Seasonal allergic rhinitis and antihistamine effects on children's learning
Vuurman, E. F. P. M., Veggel, L. M. A. V., Uiterwijk, M. M. C., Leutner, D., & O’Hanlon, J. F. (1992) · European Neuropsychopharmacology · doi:10.1016/0924-977x(92)90101-d · Cited by 332 · see citing works
The Effect of Sleep Fragmentation on Daytime Function
Martin, S. E., Engleman, H. M., Deary, I. J., & Douglas, N. J. (1996) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.153.4.8616562 · Cited by 327 · see citing works
Obstructive apneas during sleep in patients with seasonal allergic rhinitis.
(1982) · PubMed · doi:10.1164/arrd.1982.126.4.625 · Cited by 277 · see citing works
The Effect of Nonvisible Sleep Fragmentation on Daytime Function
Martin, S. E., WRAITH, P. K., Deary, I. J., & Douglas, N. J. (1997) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.155.5.9154863 · Cited by 274 · see citing works
Pathogenesis of allergic rhinitis
Baraniuk, J. N. (1997) · Journal of Allergy and Clinical Immunology · doi:10.1016/s0091-6749(97)70125-8 · Cited by 260 · see citing works
Disturbed sleep and prolonged apnea during nasal obstruction in normal men.
(1981) · PubMed · doi:10.1164/arrd.1981.124.2.158 · Cited by 247 · see citing works
Guilleminault, C., Stoohs, R. A., & Duncan, S. (1991) · CHEST Journal · doi:10.1378/chest.99.1.40 · Cited by 240 · see citing works
Measuring health-related quality of life in rhinitis
Juniper, E. F. (1997) · Journal of Allergy and Clinical Immunology · doi:10.1016/s0091-6749(97)90000-2 · Cited by 221 · see citing works
Janson, C., Backer, W. D., Gíslason, Þ., Plaschke, P. P., Bjornsson, E. H., Hetta, J. E., Kristbjarnarson, H., Vermeire, P. A., & Boman, G. (1996) · European Respiratory Journal · doi:10.1183/09031936.96.09102132 · Cited by 211 · see citing works
Breathing Disorders in Sleep Associated with “Microarousals” in Patients with Allergic Rhinitis
Lavie, P., Gertner, R., Zomer, J., & Podoshin, L. (1981) · Acta Oto-Laryngologica · doi:10.3109/00016488109133292 · Cited by 152 · see citing works
Sleep Restoration as a Function of Periodic Awakening, Movement, or Electroencephalographic Change
Bonnet, M. H. (1987) · SLEEP · doi:10.1093/sleep/10.4.364 · Cited by 112 · see citing works
Infrequent periodic sleep disruption: Effects on sleep, performance and mood
Bonnet, M. H. (1989) · Physiology & Behavior · doi:10.1016/0031-9384(89)90236-9 · Cited by 88 · see citing works
Ra, N., Bronsky, E. A., Fireman, P., Grossman, J., Cf, L., Rf, L., Ds, P., Ratner, P. H., & Rogenes, P. (1991) · PubMed · Cited by 85 · see citing works
Juniper, E. F., Guyatt, G. H., O’Byrne, P. M., & Viveiros, M. M. (1990) · Journal of Allergy and Clinical Immunology · doi:10.1016/s0091-6749(05)80101-0 · Cited by 83 · see citing works
Ratner, P. H., Paull, B. R., Findlay, S. R., Hampel, F. C., Martin, B. G., Kral, K. M., & Rogenes, P. R. (1992) · Journal of Allergy and Clinical Immunology · doi:10.1016/s0091-6749(05)80005-3 · Cited by 77 · see citing works
Orgel, H. A., Meltzer, E. O., Kemp, J. P., & Mj, W. (1986) · Journal of Allergy and Clinical Immunology · doi:10.1016/0091-6749(86)90384-2 · Cited by 68 · see citing works
Bronsky, E. A., Dockhorn, R. J., Meltzer, E. O., Shapiro, G. G., Boltansky, H., LaForce, C., Ransom, J. H., Weiler, J. M., Blumenthal, M. M., Weakley, S., et al. (1996) · Journal of Allergy and Clinical Immunology · doi:10.1016/s0091-6749(96)80065-0 · Cited by 64 · see citing works
van Bavel, J. (1994) · Archives of Internal Medicine · doi:10.1001/archinte.1994.00420230086010 · Cited by 63 · see citing works
Beclomethasone dipropionate aerosol in perennial rhinitis
Tarlo, S. M., Cockcroft, D., Dolovich, J., & Hargreave, F. E. (1977) · Journal of Allergy and Clinical Immunology · doi:10.1016/0091-6749(77)90155-5 · Cited by 58 · see citing works
Jeal, W., & Faulds, D. M. (1997) · Drugs · doi:10.2165/00003495-199753020-00006 · Cited by 55 · see citing works
Jordana, G., Dolovich, J., Briscoe, M. P., Day, J. H., Drouin, M. A., Gold, M., Robson, R. C., STEPNER, N., & Yang, W. (1996) · Journal of Allergy and Clinical Immunology · doi:10.1016/s0091-6749(96)70303-2 · Cited by 52 · see citing works
Storms, W. W., Bronsky, E. A., Findlay, S., et al. (1991) · PubMed · Cited by 43 · see citing works
Nasal cytological changes following pharmacological intervention
Meltzer, E. O. (1995) · Allergy · doi:10.1111/j.1398-9995.1995.tb02736.x · Cited by 27 · see citing works
Intranasal flunisolide, placebo and beclomethasone dipropionate in perennial rhinitis
McAllen, M. K., PORTILLO, P., Parr, E., et al. (1980) · British Journal of Diseases of the Chest · doi:10.1016/0007-0971(80)90005-4 · Cited by 25 · see citing works
Rhinitis and Sinusitis: Office Management
Guarderas, J. C. (1996) · Mayo Clinic Proceedings · doi:10.4065/71.9.882 · Cited by 12 · see citing works
Lancer, J. M., Jones, A., Stevens, J. C., et al. (1987) · The Journal of Laryngology & Otology · doi:10.1017/s0022215100101768 · Cited by 11 · see citing works
Pathogenesis of Allergic Rhinitis
Mygind, N., & Dahl, R. (1998) · Humana Press eBooks · doi:10.1007/978-1-4757-2776-0_23 · Cited by 11 · see citing works
Topical nasal steroids for allergic rhinitis.
Mj, W. (1993) · PubMed · Cited by 7 · see citing works
Diagnosis and management of seasonal and perennial allergic rhinitis.
Tan, R. A., & Siegel, S. C. (1996) · PubMed · Cited by 2 · see citing works
Intranasal flunisolide, placebo and beclomethasone dipropionate in perennial rhinitis
McAllen, M. K., PORTILLO, P., Parr, E., et al. (1980) · British Journal of Diseases of the Chest · doi:10.1016/s0007-0971(80)80168-9 · Cited by 1 · see citing works
Flagged first, then by citations
Research works printed but not linked: 3
- Leznoff A, Haight JS, Hoffstein V. Reversible obstructive sleep apnea caused by occupational exposure to guam gum dust. Am Rev Respir Dis 1986;133:935-6.
- Naclerio RM. Allergic rhinitis. N Engl J Med 1991;325:860-9.
- Guilleminault C, Stoohs R, Duncan S. Daytime sleepiness in regular heavy snorers. Chest 1991;99:40-8.
Cited by
Sorted by citations
Allergic Rhinitis and its Impact on Asthma (ARIA) 2008*
Bousquet, J., Khaltaev, N., Cruz, A. A., Denburg, J., Fokkens, W. J., Togias, A., Zuberbier, T., Baena‐Cagnani, C. E., Canonica, G. W., Van Weel, C., et al. (2008) · Allergy · doi:10.1111/j.1398-9995.2007.01620.x · Cited by 4,729 · see citing works
Allergic Rhinitis and Its Impact on Asthma
Bousquet, J., van Cauwenberge, P., & Khaltaev, N. (2001) · Journal of Allergy and Clinical Immunology · doi:10.1067/mai.2001.118891 · Cited by 3,588 · see citing works
Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 Revision
Brożek, J. L., Bousquet, J., Baena-Cagnani, C. E., Bonini, S., Canonica, G. W., Casale, T. B., van Wijk, R. G., Ohta, K., Zuberbier, T., & Schünemann, H. J. (2010) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2010.06.047 · Cited by 1,813 · see citing works
Clinical Practice Guideline: Allergic Rhinitis
Seidman, M. D., Gurgel, R. K., Lin, S. Y., Schwartz, S. R., Baroody, F. M., Bonner, J. R., Dawson, D. E., Dykewicz, M. S., Hackell, J. M., Han, J. K., et al. (2015) · Otolaryngology–Head and Neck Surgery · doi:10.1177/0194599814561600 · Cited by 671 · see citing works
International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis
Wise, S. K., Lin, S. Y., Toskala, E., Orlandi, R. R., Akdis, C. A., Alt, J. A., Azar, A., Baroody, F. M., Bachert, C., Canonica, G. W., et al. (2018) · International Forum of Allergy & Rhinology · doi:10.1002/alr.22073 · Cited by 557 · see citing works
Severity and impairment of allergic rhinitis in patients consulting in primary care
Bousquet, J., Neukirch, F., Bousquet, P. J., Gehano, P., Klossek, J. M., Le Gal, M., & Allaf, B. (2006) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2005.09.047 · Cited by 298 · see citing works
The role of the nose in snoring and obstructive sleep apnoea: an update
Georgalas, C. (2011) · European Archives of Oto-Rhino-Laryngology · doi:10.1007/s00405-010-1469-7 · Cited by 239 · see citing works
Stuck, B. A., Czajkowski, J., Hagner, A.-E., Klimek, L., Verse, T., Hörmann, K., & Maurer, J. T. (2004) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2003.12.589 · Cited by 181 · see citing works
Effect of treating severe nasal obstruction on the severity of obstructive sleep apnoea
McLean, H. A., Urton, A. M., Driver, H. S., Tan, A. K. W., Day, A. G., Munt, P. W., & Fitzpatrick, M. F. (2005) · European Respiratory Journal · doi:10.1183/09031936.05.00045004 · Cited by 142 · see citing works
Shedden, A. (2005) · Treatments in Respiratory Medicine · doi:10.2165/00151829-200504060-00007 · Cited by 137 · see citing works
Randomised trial of nasal surgery for fixed nasal obstruction in obstructive sleep apnoea
Koutsourelakis, I., Georgoulopoulos, G., Perraki, E., Vagiakis, E., Roussos, C., & Zakynthinos, S. G. (2008) · European Respiratory Journal · doi:10.1183/09031936.00087607 · Cited by 131 · see citing works
Influences of Allergic Rhinitis on Sleep
Ferguson, B. J. (2004) · Otolaryngology–Head and Neck Surgery · doi:10.1016/j.otohns.2004.02.001 · Cited by 124 · see citing works
Immune Mediators in Allergic Rhinitis and Sleep
Krouse, H. J., Davis, J. E., & Krouse, J. H. (2002) · Otolaryngology–Head and Neck Surgery · doi:10.1067/mhn.2002.125300 · Cited by 120 · see citing works
Hughes, K., Glass, C., Ripchinski, M., Gurevich, F., Weaver, T. E., Lehman, E., Fisher, L. H., & Craig, T. J. (2003) · Allergy · doi:10.1034/j.1398-9995.2003.00093.x · Cited by 113 · see citing works
Self-citationMansfield, L. E., Diaz, G., Posey, C. R., & Flores-Neder, J. (2004) · Annals of Allergy, Asthma & Immunology · doi:10.1016/s1081-1206(10)61554-2 · Cited by 106 · see citing works
Effects of nasal surgery on sleep quality in obstructive sleep apnea syndrome with nasal obstruction
Nakata, S., Noda, A., Yasuma, F., Morinaga, M., Sugiura, M., Katayama, N., Sawaki, M., Teranishi, M., & Nakashima, T. (2008) · American Journal of Rhinology · doi:10.2500/ajr.2008.22.3120 · Cited by 104 · see citing works
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Brawley, A., Silverman, B., Kearney, S., Guanzon, D., Owens, M., Bennett, H., & Schneider, A. (2004) · Annals of Allergy, Asthma & Immunology · doi:10.1016/s1081-1206(10)61434-2 · Cited by 95 · see citing works
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Parthasarathy, S., Wendel, C., Haynes, P. L., Atwood, C., & Kuna, S. (2013) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.2744 · Cited by 77 · see citing works
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Scadding, G. (2010) · Pediatric Allergy and Immunology · doi:10.1111/j.1399-3038.2010.01012.x · Cited by 72 · see citing works
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Canova, C. R., Downs, S. H., Knoblauch, A., Andersson, M., Tamm, M., & Leuppi, J. D. (2004) · Respiration · doi:10.1159/000076674 · Cited by 74 · see citing works
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Craig, T. J., Ferguson, B. J., & Krouse, J. H. (2008) · American Journal of Otolaryngology · doi:10.1016/j.amjoto.2007.06.002 · Cited by 70 · see citing works
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Craig, T. J., Hanks, C. D., & Fisher, L. H. (2005) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2005.10.009 · Cited by 69 · see citing works
Self-citationGolden, S., Teets, S. J., Lehman, E. B., Mauger, E. A., Chinchilli, V., Berlin, J. M., Kakumanu, S., Lucus, T., & Craig, T. J. (2000) · Annals of Allergy, Asthma & Immunology · doi:10.1016/s1081-1206(10)62434-9 · Cited by 46 · see citing works
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Awad, M. I., & Kacker, A. (2018) · Otolaryngologic Clinics of North America · doi:10.1016/j.otc.2018.05.012 · Cited by 41 · see citing works
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Rimmer, J., Downie, S., Bartlett, D. J., Gralton, J., & Salome, C. (2009) · Annals of Allergy, Asthma & Immunology · doi:10.1016/s1081-1206(10)60180-9 · Cited by 32 · see citing works
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Victores, A. J., & Takashima, M. (2012) · The Laryngoscope · doi:10.1002/lary.23584 · Cited by 32 · see citing works
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Self-citation
- Authors
- Craig, T. J., Teetsb, S., Lehman, E. B., Chinchilli, V. M., & Zwillich, C.
- Affiliations
- Pennsylvania State University (US)
- Hershey (United States) (US)
- Denver VA Medical Center (US)
- Venue
- Journal of Allergy and Clinical Immunology
- Publisher
- Elsevier BV
- Published
- 1998-05
- Volume
- 101
- Issue
- 5
- Pages
- 633-637
- ISSN
- 0091-6749 (ISSN-L)
- OpenAlex
- W2131100693
- Cited by
- 249
- References
- 33
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 4 · 2023: 6 · 2022: 4 · 2021: 8 · 2020: 6 · 2019: 8 · 2018: 12 · 2017: 5 · 2016: 9 · 2015: 10 · 2014: 9 · 2013: 8 · 2012: 7
- FWCI
- 2.52
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Allergy and Clinical Immunology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Immunology and Allergy › Allergic Rhinitis and Sensitization
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Medicine › Surgery › Nasal Surgery and Airway Studies
- Keywords
- allergic rhinitis, nasal congestion, intranasal corticosteroids, sleep disorders, daytime fatigue, nasal obstruction, sleep fragmentation
- MeSH terms
- Administration, Topical, Adolescent, Adrenal Cortex Hormones, Adult, Double-Blind Method, Fatigue, Humans, Middle Aged, Rhinitis, Allergic, Perennial, Sleep Apnea Syndromes, Nasal Obstruction, Treatment Outcome, Cross-Over Studies, Anti-Allergic Agents
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