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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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 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
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 (www.shhi.org) 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)
For this type of study, formal consent is not required.
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.
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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). https://doi.org/10.1007/s11325-016-1322-3
- Nonallergic rhinitis
- Allergic rhinitis
- Sleep-disordered breathing
- Nonrestorative sleep