Allergic Rhinitis and Inner-City Children–Is There a Relationship to Sleep-Disordered Breathing?

Abstract

RATIONALE: Allergic rhinitis (AR), common in children, causes increased upper airway resistance and may lead to sleep-disordered breathing (SDB), which often goes undiagnosed. The goals of this study were to assess the pattern of aeroallergen sensitization in inner-city pediatric patients with SDB and to determine if intranasal corticosteroid treatment improves SDB, using a validated Pediatric Sleep Questionnaire (PSQ). METHODS: Patients (ages 2-18) were evaluated for AR and completed the PSQ prior to treatment. Skin prick testing (SPT) to aeroallergens, including inner-city culprits (rat, cockroach, and mouse), was performed. Patients with a history of AR, SPT evaluation, and at least one positive response on the PSQ were treated with intranasal mometasone furoate monohydrate, environmental control, (+/−) antihistamines. After six weeks of treatment, PSQ responses were reassessed. RESULTS: Of the 24 patients recruited in this ongoing study, 100% had SDB as per PSQ responses; 91% had ≥1 positive SPT, 75% of which were SPT-positive to cockroach, mouse, or rat. Prior to treatment, patients' average PSQ score = 5.96 questions; following treatment, an average PSQ score = 2.38, indicating clinical improvement (p<0.0001 paired t test.) CONCLUSIONS: Children suffering from AR have increased nasal obstruction leading to sleep-disordered events. This study demonstrated adequate treatment, including an intranasal steroid, may significantly improve SDB, as per PSQ results. In inner-city children, elimination of indoor allergens such as cockroach, mouse, or rat may further improve SDB. Larger prospective studies are needed to further validate these preliminary results.