Impact and Assessment of Sleep Disturbance in Adults and Children with Allergic Rhinitis

Abstract

In this article, we review the impact and the treatment of sleep disturbance caused by allergic rhinitis (AR) in adult and pediatric patients. Although intranasal corticosteroids (INS) remain the mainstay treatments for AR-induced sleep disturbance, allergen immunotherapy (AIT) has been suggested to be effective in altering the course and progression of moderate-to-severe AR that is refractory to pharmacotherapy. MP-AzeFlu is a recently developed formulation containing azelastine, an intranasal antihistamine (INAH), and fluticasone propionate, an INS. MP-AzeFlu has been reported to have a fast onset of action thanks to the effect of the INAH. AR is one of the most common chronic inflammatory diseases in the USA with symptoms that can severely affect patients’ quality of life. Sleep disturbance is a serious consequence of AR-induced symptoms that can lead to daytime somnolence, impaired cognitive functions, and decreased work/school performance. Nasal congestion and rhinorrhea have been suggested to be the primary causes of sleep disturbance in patients with AR. There is a lack of adequate assessment method for AR-induced sleep disturbance and its consequences in the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines and the Sino-Nasal Outcome Test-22 (SNOT-22). The NIH-developed Patient Reported Outcome Measurement Information System (PROMIS) has measures for these symptoms. Although more research is needed to develop more pediatric-specific questionnaires, PROMIS is a good start. In terms of treatment for AR-induced sleep disturbance, therapy should be aimed at treating the nasal congestion and rhinorrhea caused by AR. INS are the mainstay treatments for moderate-to-severe AR. The newer INS have low systemic bioavailability and are well tolerated. For adults, fluticasone propionate is an effective treatment. For children from 2 to 4 years old, mometasone and fluticasone furoate are recommended. Fluticasone propionate should be used in children age 4 or older. Budesonide is the only category B safety drug as classified by the FDA, making it recommended treatment for pregnant and breastfeeding women.