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Prevalence of potential nonallergic rhinitis at a community-based sleep medical center



Nonallergic rhinitis (NAR) is a common condition involving symptomatic nasal congestion, stuffiness, or rhinorrhea, which overlap with symptoms of allergic rhinitis. Scant research has examined NAR and sleep. The aim of this study was to assess the frequency of potential NAR symptoms in a large sample of sleep center patients.


A retrospective chart review was conducted on 2658 adult patients at our sleep center from 2008 to 2012; 1703 reported clinically relevant nasal congestion. For this subset, potential NAR status (NAR+ vs NAR−) was determined using a brief survey. NAR groups were further divided into three sub-groups based on presenting chief complaints: insomnia (INS), nonrestorative sleep (NRS), and sleep-disordered breathing (SDB). Patients objectively diagnosed with SDB were also analyzed by NAR status. Validated scales for sleepiness, insomnia, anxiety, and depression were compared among the groups.


Potential NAR+ comprised 70 % (1194 of 1703) of patients with congestion and showed significantly higher congestion scores than NAR− status [11.97 (3.62) vs 10.47 (3.37); p = .001; g = 0.42; 95 % CI, 0.32–0.53]. The proportion of potential NAR+ cases for each presenting chief complaint was nearly identical (range 69.6 to 71.2 %). However, the comparison of effects between NAR+ and NAR− cases within each presenting group (INS, NRS, SDB) was more consistently significant on the scales for insomnia, sleepiness, anxiety, and depression only in the SDB category. The same four symptoms, measured in those objectively diagnosed with SDB, were also significantly worse in NAR+ compared to NAR− patients.


Regardless of presenting chief complaint and ultimate diagnosis of sleep-disordered breathing, potential nonallergic rhinitis was common in patients at a sleep medical center at a rate possibly greater than twice that reported in the general population. Potential NAR+ was associated with worse sleep and distress symptoms. In both prevalence and treatment studies, research must further evaluate the potential impact of NAR on specific sleep disorders.

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  1. Staevska MT, Baraniuk JN (2007) Differential diagnosis of persistent nonallergic rhinitis and rhinosinusitis syndromes. Clin Allergy Immunol 19:35–53

    Article  PubMed  Google Scholar 

  2. Bhargava D, Bhargava K, Al-Abri A, Al-Bassam W, Al-Abri R (2011) Non allergic rhinitis: prevalence, clinical profile and knowledge gaps in literature. Oman Med J 26:416–420

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kaliner MA (2011) Nonallergic rhinopathy (formerly known as vasomotor rhinitis). Immunol Allergy Clin North Am 31:441–455

    Article  PubMed  Google Scholar 

  4. Lieberman P (2001) Treatment update: nonallergic rhinitis. Allergy Asthma Proc 22:199–202

    CAS  PubMed  Google Scholar 

  5. Settipane RA, Kaliner MA (2013) Chapter 14: nonallergic rhinitis. Am J Rhinol Allergy 27(Suppl 1):S48–S51

    Article  PubMed  Google Scholar 

  6. Quillen DM, Feller DB (2006) Diagnosing rhinitis: allergic vs. nonallergic. Am Fam Physician 73:1583–1590

    PubMed  Google Scholar 

  7. Olsson P, Berglind N, Bellander T, Stjarne P (2003) Prevalence of self-reported allergic and non-allergic rhinitis symptoms in Stockholm: relation to age, gender, olfactory sense and smoking. Acta Otolaryngol 123:75–80

    Article  PubMed  Google Scholar 

  8. Bernstein JA (2010) Allergic and mixed rhinitis: epidemiology and natural history. Allergy Asthma Proc 31:365–369

    Article  PubMed  Google Scholar 

  9. Lieberman P, Pattanaik D (2014) Nonallergic rhinitis. Curr Allergy Asthma Rep 14:439

    Article  PubMed  Google Scholar 

  10. Settipane RA (2009) Epidemiology of vasomotor rhinitis. World Allergy Organ J 2:115–118

    Article  PubMed  PubMed Central  Google Scholar 

  11. Craig TJ, Teets S, Lehman EB, Chinchilli VM, Zwillich C (1998) Nasal congestion secondary to allergic rhinitis as a cause of sleep disturbance and daytime fatigue and the response to topical nasal corticosteroids. J Allergy Clin Immunol 101:633–637

    Article  CAS  PubMed  Google Scholar 

  12. Thompson A, Sardana N, Craig TJ (2013) Sleep impairment and daytime sleepiness in patients with allergic rhinitis: the role of congestion and inflammation. Ann Allergy Asthma Immunol 111:446–451

    Article  PubMed  Google Scholar 

  13. Kimple AJ, Ishman SL (2013) Allergy and sleep-disordered breathing. Curr Opin Otolaryngol Head Neck Surg 21:277–281

    Article  PubMed  Google Scholar 

  14. Kalpaklioglu AF, Kavut AB, Ekici M (2009) Allergic and nonallergic rhinitis: the threat for obstructive sleep apnea. Ann Allergy Asthma Immunol 103:20–25

    Article  PubMed  Google Scholar 

  15. Kiely JL, Nolan P, McNicholas WT (2004) Intranasal corticosteroid therapy for obstructive sleep apnoea in patients with co-existing rhinitis. Thorax 59:50–55

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Ingram JM, Sporik R, Rose G, Honsinger R, Chapman MD, Platts-Mills TA (1995) Quantitative assessment of exposure to dog (Can f 1) and cat (Fel d 1) allergens: relation to sensitization and asthma among children living in Los Alamos, New Mexico. J Allergy Clin Immunol 96:449–456

    Article  CAS  PubMed  Google Scholar 

  17. Pynnonen MA, Kim HM, Terrell JE (2009) Validation of the Sino-Nasal Outcome Test 20 (SNOT-20) domains in nonsurgical patients. Am J Rhinol Allergy 23:40–45

    Article  PubMed  Google Scholar 

  18. Kaliner MA (2007) A novel and effective approach to treating rhinitis with nasal antihistamines. Ann Allergy Asthma Immunol 99:383–390

    Article  PubMed  Google Scholar 

  19. Kaliner MA (2009) Azelastine and olopatadine in the treatment of allergic rhinitis. Ann Allergy Asthma Immunol 103:373–380

    Article  CAS  PubMed  Google Scholar 

  20. Bernstein JA, Salapatek AM, Lee JS, Nelson V, Wilson D, D’Angelo P, Tsitoura D, Murdoch R, Patel D (2012) Provocation of nonallergic rhinitis subjects in response to simulated weather conditions using an environmental exposure chamber model. Allergy Asthma Proc 33:333–340

    Article  PubMed  Google Scholar 

  21. Bastien CH, Vallieres A, Morin CM (2001) Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med 2:297–307

    Article  PubMed  Google Scholar 

  22. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545

    CAS  PubMed  Google Scholar 

  23. Hesbacher PT, Rickels K, Morris RJ, Newman H, Rosenfeld H (1980) Psychiatric illness in family practice. J Clin Psychiatry 41:6–10

    CAS  PubMed  Google Scholar 

  24. Berry RB, Brooks R, Gamaldo CE, Harding SM, Marcus CL, Vaughn BV. (2012) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, Version 2.0. 27:1569–73

  25. Kushida CA, Chediak A, Berry RB, Brown LK, Gozal D, Iber C, Parthasarathy S, Quan SF, Rowley JA (2008) Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med 4:157–171

    PubMed  Google Scholar 

  26. Krakow B, Krakow J, Ulibarri VA, McIver ND (2014) Frequency and accuracy of “RERA” and “RDI” terms in the Journal of Clinical Sleep Medicine from 2006 through 2012. J Clin Sleep Med 10:121–124

    PubMed  PubMed Central  Google Scholar 

  27. Addolorato G, Ancona C, Capristo E, Graziosetto R, Di RL, Maurizi M, Gasbarrini G (1999) State and trait anxiety in women affected by allergic and vasomotor rhinitis. J Psychosom Res 46:283–289

    Article  CAS  PubMed  Google Scholar 

  28. Tomljenovic D, Pinter D, Kalogjera L (2014) Perceived stress and severity of chronic rhinosinusitis in allergic and nonallergic patients. Allergy Asthma Proc 35:398–403

    Article  PubMed  Google Scholar 

  29. Krakow B, Ulibarri VA,McIver ND. (2014) Pharmacotherapeutic failure in a large cohort of patients with insomnia presenting to a sleep medicine center and laboratory: subjective pretest predictions and objective diagnoses. Mayo Clin Proc

  30. Germain A, Shear MK, Hall M, Buysse DJ (2007) Effects of a brief behavioral treatment for PTSD-related sleep disturbances: a pilot study. Behav Res Ther 45:627–632

    Article  PubMed  Google Scholar 

  31. Staevska MT, Baraniuk JN (2007) Rhinitis and sleep apnea. Clin Allergy Immunol 19:449–472

    PubMed  Google Scholar 

  32. Strobel W, Schlageter M, Andersson M, Miedinger D, Chhajed PN, Tamm M, Leuppi JD (2011) Topical nasal steroid treatment does not improve CPAP compliance in unselected patients with OSAS. Respir Med 105:310–315

    Article  PubMed  Google Scholar 

  33. Kalan A, Kenyon GS, Seemungal TA, Wedzicha JA (1999) Adverse effects of nasal continuous positive airway pressure therapy in sleep apnoea syndrome. J Laryngol Otol 113:888–892

    Article  CAS  PubMed  Google Scholar 

  34. Georgalas C (2011) The role of the nose in snoring and obstructive sleep apnoea: an update. Eur Arch Otorhinolaryngol 268:1365–1373

    Article  PubMed  PubMed Central  Google Scholar 

  35. Staevska MT, Mandajieva MA, Dimitrov VD (2004) Rhinitis and sleep apnea. Curr Allergy Asthma Rep 4:193–199

    Article  PubMed  Google Scholar 

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Correspondence to Barry Krakow.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


No funding was received for this research.

Conflict of interest

Ms. Foley-Shea, Ms. McIver, Mr. Ulibarri, and Dr. Honsinger certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or nonfinancial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript. Dr. Krakow has multiple disclosures that are related to his work in sleep medicine. They are as follows:

For websites:

For other professional services: Medical director of a national DME company Classic Sleep Care for which sole functions are consultation and QA; neither patient encounters nor benefit from the sale of any DME equipement.

For intellectual property: Markets and sells 3 books for sleep disorders patients

  • Insomnia Cures

  • Turning Nightmares into Dreams

  • Sound Sleep, Sound Mind

For clinical services: Owns and operates one commercial sleep center

  • Maimonides Sleep Arts & Sciences, Ltd

For educational and consulting services: Conducts CME/CEU educational programs for medical and mental health providers to learn about sleep disorders.

President of a non-profit sleep research center, the Sleep ∓ Human Health Institute ( that occasionally provides consultation services or receives grants for pilot studies, the most recent of which were:

  • ResMed ~$400,000 January 2015 (funding for randomized control trial of treatment in insomnia patients)

Retrospective study

For this type of study, formal consent is not required.

Additional information


This is a retrospective, single center study of the prevalence of potential nonallergic rhinitis (NAR) in patients presenting to a sleep center. Patients answered questionnaires to identify nasal symptoms and to categorize them as potential NAR or other nasal symptoms (likely predominantly allergic). The use of a non-validated questionnaire is a clear drawback, and the entity identified as NAR likely represents mixed etiologies of symptoms in these patients. Similarly, allergy testing was not performed to formally exclude allergic rhinitis. Nevertheless, the study brings to attention to the sleep community the problem of NAR, which appears to be common based on the authors’ data, occurring in 45% of patients presenting to their sleep center. NAR, compared with other forms of nasal symptoms, was associated with greater sleepiness, insomnia, anxiety and depression scores, particularly in the group with a complaint of sleep-disordered breathing, as well as those with confirmed sleep-disordered breathing, though effect sizes were for the most part modest. Why those with NAR should have greater symptoms than those with other forms of rhinitis or congestion is not clear. One possibility is the failure to recognize and treat the problem. Another is that the questionnaire identified individuals with greater severity of nasal symptoms. NAR may be especially important in the context of OSA because it might contribute to OSA pathogenesis, and be an important factor in the success of CPAP treatment. This study opens the way for further research on NAR in the context of sleep disorders.

Marta Kaminska

Montreal, Canada

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Krakow, B., Foley-Shea, M., Ulibarri, V.A. et al. Prevalence of potential nonallergic rhinitis at a community-based sleep medical center. Sleep Breath 20, 987–993 (2016).

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  • Nonallergic rhinitis
  • Allergic rhinitis
  • Sleep-disordered breathing
  • Insomnia
  • Nonrestorative sleep