Skip to main content

Where does Allergy Management Fit in Obstructive Sleep Apnea?

Abstract

Purpose of the review

Obstructive sleep apnea (OSA) and allergic rhinitis (AR) are common airway disorders which often coexist. The effect of nasal allergy symptoms and treatment for AR on sleep parameters and OSA has been studied. The purpose of this review is to present recent data on the role of allergy management on the treatment of OSA.

Recent findings

Recent literature supports the use of second-generation antihistamines, intranasal corticosteroids and/ or immunotherapy to reduce the inflammatory conditions in the nose, reduce nasal resistance and improve CPAP use. The impact of allergic rhinitis on sleep testing is unknown and may worsen the diagnosis of OSA, resulting in false positive and false negative results. A meta-analysis of recent surgical literature found that correction of nasal deformities and reduction of nasal resistance through nasal surgical interventions resulted in reduced nasal resistance and improved compliance of nasal CPAP.

Summary

The complex relationship between OSA and allergic rhinitis has been examined. Patients with OSA benefit from recognition of AR and treatment of the nasal airway for improved CPAP compliance and airway inflammation.

This is a preview of subscription content, access via your institution.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Cao Y, Wu S, Zhang L, Yang Y, Cao S, Li Q. Association of allergic rhinitis with obstructive sleep apnea: A meta-analysis. Medicine. 2018 Dec;97(51).

  2. McColley SA, Carroll JL, Curtis S, et al. High prevalence of allergic sensitization in children with habitual snoring and obstructive sleep apnea. Chest. 1997;111:170–3.

    CAS  Article  Google Scholar 

  3. Young T, Finn L, Kim H. Nasal obstruction as a risk factor for sleep-disordered breathing. The University of Wisconsin Sleep and Respiratory Research Group. J Allergy Clin Immunol. 1997;99(2):S757–62.

  4. Young T, Finn L, Palta M. Chronic nasal congestion at night is a risk factor for snoring in a population-based cohort study. Arch Intern Med. 2001;161:1514–9.

    CAS  Article  Google Scholar 

  5. Chirakalwasan N, Rusrungtham K. The linkage of allergic rhinitis and obstructive sleep apnea. Asian Pac J Allergy Immunol. 2014;32:276–86.

    PubMed  Google Scholar 

  6. Tam YY, Shao IH, Wu CC, Hsieh ML. The impact of intranasal fluticasone on patients with obstructive sleep apnea: a prospective study. Braz J Otorhinolaryngol. 2021;87(2):152–6.

  7. Brouillette RT, Manoukian JJ, Ducharme FM, Oudjhane K, Earle LG, Ladan S, Morielli A. Efficacy of fluticasone nasal spray for pediatric obstructive sleep apnea. J Pediatr. 2001;138(6):838–44.

  8. Jeffery PK, Haahtela T. Allergic rhinitis and asthma: inflammation in a one-airway condition. BMC Pulm Med. 2006;6(1):1–2.

  9. •• Wise SK, Lin SY, Toskala E, Orlandi RR, Akdis CA, Alt JA, Azar A, Baroody FM, Bachert C, Canonica GW, Chacko T. International consensus statement on allergy and rhinology: allergic rhinitis. InInternational forum of allergy & rhinology. 2018;8(2):108–352. https://doi.org/10.1002/alr.22073. This resource provides a wealth of validated information on the impact, burden, diagnosis and treatment of AR- including AR’s sleep and OSA effects.

  10. • Damask CC, Ryan MW, Casale TB, Castro M, Franzese CB et al. Targeted Molecular Therapies in Allergy and Rhinology. Otolaryngol Head Neck Surg. 2021;164(1_suppl):S1–S21. This white paper on biologics and AR gives references and common ground for integration of target immunotherapy.

  11. Thompson A, Sardana N, Craig TJ. Sleep impairment and daytime sleepiness in patients with allergic rhinitis: the role of congestion and inflammation. Ann Allergy Asthma Immunol. 2013;111(6):446–51. https://doi.org/10.1016/j.anai.2013.05.020.

    Article  PubMed  Google Scholar 

  12. Rimmer J, Downie S, Bartlett DJ, Gralton J, Salome C. Sleep disturbance in persistent allergic rhinitis measured using actigraphy. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology. 2009;103(3):190–4. https://doi.org/10.1016/S1081-1206(10)60180-9.

    Article  Google Scholar 

  13. Parikh NG, Junaid I, Sheinkopf L, Randhawa I, Santiago SM, Klaustermeyer WB. Clinical control in the dual diagnosis of obstructive sleep apnea syndrome and rhinitis: a prospective analysis. Am J Rhinol Allergy. 2014;28(1):e52–5. https://doi.org/10.2500/ajra.2014.28.3977.

    Article  PubMed  Google Scholar 

  14. Young T, Finn L, Kim H. Nasal obstruction as a risk factor for sleep-disordered breathing. J Allergy Clin Immunol. 1997;99(2):S757–62. https://doi.org/10.1016/s0091-6749(97)70124-6

  15. Lunn M, Craig T. Rhinitis and sleep. Sleep Med Rev. 2011;15(5):293–9. https://doi.org/10.1016/j.smrv.2010.12.001.

    Article  PubMed  Google Scholar 

  16. Gao Z, Chen X, Xiang R, Zhang W, Tan L, Fan W, Liu P, Lv H, Xu Y. Changes in Resting-State Spontaneous Brain Activity in Patients With Allergic Rhinitis: A Pilot Neuroimaging Study. Front Neurosci. 2021;15: 697299. https://doi.org/10.3389/fnins.2021.697299.

    Article  PubMed  PubMed Central  Google Scholar 

  17. McNicholas WT, Coffey M, Boyle T. Effects of nasal airflow on breathing during sleep in normal humans. Am Rev Respir Dis. 1993;147(3):620–3. https://doi.org/10.1164/ajrccm/147.3.620.

    CAS  Article  PubMed  Google Scholar 

  18. Basner RC, Simon PM, Schwartzstein RM, Weinberger SE, Weiss JW. Breathing route influences upper airway muscle activity in awake normal adults. J Appl Physiol. 1989;66(4):1766–71. https://doi.org/10.1152/jappl.1989.66.4.1766

  19. Remmers JE, deGroot WJ, Sauerland EK, Anch AM. Pathogenesis of upper airway occlusion during sleep. Journal of applied physiology: respiratory, environmental and exercise physiology. 1978;44(6):931–8. https://doi.org/10.1152/jappl.1978.44.6.931.

    CAS  Article  Google Scholar 

  20. Bonekat HW, Hardin KA. Severe upper airway obstruction during sleep. Clin Rev Allergy Immunol. 2003;25(2):191–210. https://doi.org/10.1385/CRIAI:25:2:191.

    Article  PubMed  Google Scholar 

  21. Papsidero MJ. The Nose and Its Impact on Snoring and Obstructive Sleep Apnea. Lippincott Williams & Wilkins; 2003.

    Google Scholar 

  22. Houser SM, Mamikoglu B, Aquino BF, Moinuddin R, Corey JP. Acoustic rhinometry findings in patients with mild sleep apnea. Otolaryngology-Head and Neck Surgery. 2002;126(5):475–80. https://doi.org/10.1067/mhn.2002.124848

  23. McNicholas WT, Tarlo S, Cole P, Zamel N, Rutherford R, Griffin D, Phillipson EA. Obstructive apneas during sleep in patients with seasonal allergic rhinitis. Am Rev Respir Dis. 1982;126(4):625–8. https://doi.org/10.1164/arrd.1982.126.4.625.

    CAS  Article  PubMed  Google Scholar 

  24. Kiely JL, Nolan P, McNicholas WT. Intranasal corticosteroid therapy for obstructive sleep apnoea in patients with co-existing rhinitis. Thorax. 2004;59(1):50–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  25. Lavigne F, Petrof BJ, Johnson JR, Lavigne P, Binothman N, Kassissia GO, Al Samri M, Giordano C, Dubé N, Hercz D, Benedetti A, Hamid Q. Effect of topical corticosteroids on allergic airway inflammation and disease severity in obstructive sleep apnoea. Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology. 2013;43(10):1124–33. https://doi.org/10.1111/cea.12158.

    CAS  Article  Google Scholar 

  26. Demain JG, Goetz DW. Pediatric adenoidal hypertrophy and nasal airway obstruction: reduction with aqueous nasal beclomethasone. Pediatrics. 1995;95(3):355–64.

    CAS  Article  Google Scholar 

  27. Morgenthaler TI, Kapen S, Lee-Chiong T, Alessi C, Boehlecke B, Brown T, Coleman J, Friedman L, Kapur V, Owens J, Pancer J, Swick T. Standards of Practice Committee, & American Academy of Sleep Medicine Practice parameters for the medical therapy of obstructive sleep apnea. Sleep. 2006;29(8):1031–5.

    Article  Google Scholar 

  28. Strobel W, Schlageter M, Andersson M, Miedinger D, Chhajed PN, Tamm M, Leuppi JD. Topical nasal steroid treatment does not improve CPAP compliance in unselected patients with OSAS. Respir Med. 2011;105(2):310–5. https://doi.org/10.1016/j.rmed.2010.10.003.

    Article  PubMed  Google Scholar 

  29. Ji T, Lu T, Qiu Y, Li X, Liu Y, Tai J, Guo Y, Zhang J, Wang S, Zhao J, Ni X, Xu Z. The efficacy and safety of montelukast in children with obstructive sleep apnea: a systematic review and meta-analysis. Sleep Med. 2021;78:193–201. https://doi.org/10.1016/j.sleep.2020.11.009.

    Article  PubMed  Google Scholar 

  30. Goldbart AD, Goldman JL, Li RC, Brittian KR, Tauman R, Gozal D. Differential expression of cysteinyl leukotriene receptors 1 and 2 in tonsils of children with obstructive sleep apnea syndrome or recurrent infection. Chest. 2004;126(1):13–8. https://doi.org/10.1378/chest.126.1.13.

    CAS  Article  PubMed  Google Scholar 

  31. Tsaoussoglou M, Hatzinikolaou S, Baltatzis GE, Lianou L, Maragozidis P, Balatsos NA, Chrousos G, Kaditis AG. Expression of leukotriene biosynthetic enzymes in tonsillar tissue of children with obstructive sleep apnea: a prospective nonrandomized study. JAMA Otolaryngology–Head & Neck Surgery. 2014;140(10):944–50. https://doi.org/10.1001/jamaoto.2014.1936

  32. Shusterman D, Baroody FM, Craig T, Friedlander S, Nsouli T, Silverman B, American Academy of Allergy A. Role of the allergist-immunologist and upper airway allergy in sleep-disordered breathing. J Allergy Clin Immunol Pract. 2017;5(3):628–39. https://doi.org/10.1016/j.jaip.2016.10.007

  33. Sherkat AA, Sardana N, Safaee S, Lehman EB, Craig TJ. The role of pseudoephedrine on daytime somnolence in patients suffering from perennial allergic rhinitis (PAR). Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology. 2011;106(2):97–102. https://doi.org/10.1016/j.anai.2010.11.013.

    CAS  Article  Google Scholar 

  34. Fontanari P, Zattara-Hartmann MC, Burnet H, Jammes Y. Nasal eupnoeic inhalation of cold, dry air increases airway resistance in asthmatic patients. Eur Respir J. 1997;10(10):2250–4. https://doi.org/10.1183/09031936.97.10102250.

    CAS  Article  PubMed  Google Scholar 

  35. Ferguson BJ. Influences of allergic rhinitis on sleep. Otolaryngology—Head and Neck Surgery. 2004;130(5):617–29. https://doi.org/10.1016/j.otohns.2004.02.001

  36. Fein MN, Fischer DA, O’Keefe AW, Sussman GL. CSACI position statement: Newer generation H1-antihistamines are safer than first-generation H1-antihistamines and should be the first-line antihistamines for the treatment of allergic rhinitis and urticaria. Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology. 2019;15:61. https://doi.org/10.1186/s13223-019-0375-9.

    CAS  Article  Google Scholar 

  37. Boyle J, Eriksson M, Stanley N, Fujita T, Kumagi Y. Allergy medication in Japanese volunteers: treatment effect of single doses on nocturnal sleep architecture and next day residual effects. Curr Med Res Opin. 2006;22(7):1343–51. https://doi.org/10.1185/030079906X112660.

    Article  PubMed  Google Scholar 

  38. Mann RD, Pearce GL, Dunn N, Shakir S. Sedation with “non-sedating” antihistamines: four prescription-event monitoring studies in general practice. BMJ (Clinical research ed). 2000;320(7243):1184–6. https://doi.org/10.1136/bmj.320.7243.1184.

    CAS  Article  Google Scholar 

  39. Scioscia G, Buonamico E, Foschino Barbaro MP, Lacedonia D, Sabato R, Carpagnano GE. Omalizumab as add-on therapy in a patient with severe asthma and OSA. Respirology case reports. 2020;8(2): e0518. https://doi.org/10.1002/rcr2.518.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Lin SY, Melvin TA, Boss EF, Ishman SL. The association between allergic rhinitis and sleep-disordered breathing in children: a systematic review. International forum of allergy & rhinology. 2013;3(6):504–9. https://doi.org/10.1002/alr.21123.

    Article  Google Scholar 

  41. Léger D, Annesi-Maesano I, Carat F, Rugina M, Chanal I, Pribil C, El Hasnaoui A, Bousquet J. Allergic rhinitis and its consequences on quality of sleep: An unexplored area. Arch Intern Med. 2006;166(16):1744–8. https://doi.org/10.1001/archinte.166.16.1744.

    Article  PubMed  Google Scholar 

  42. Koinis-Mitchell D, Craig T, Esteban CA, Klein RB. Sleep and allergic disease: a summary of the literature and future directions for research. J Allergy Clin Immunol. 2012;130(6):1275–81.

    Article  Google Scholar 

  43. Zheng M, Wang X, Ge S, Gu Y, Ding X, Zhang Y, Ye J, Zhang L. Allergic and Non-Allergic Rhinitis Are Common in Obstructive Sleep Apnea but Not Associated With Disease Severity. J Clin Sleep Med. 2017;13(8):959–66.

    Article  Google Scholar 

  44. Berson SR, Klimczak JA, Prezio EA, Abraham MT. House Dust Mite Related Allergic Rhinitis and REM Sleep Disturbances. Am J Otolaryngol. 2020;41(6):102709.

    Article  Google Scholar 

  45. Krouse HJ, Davis JE, Krouse JH. Immune mediators in allergic rhinitis and sleep. Otolaryngol Head Neck Surg. 2002;126(6):607–13.

    Article  Google Scholar 

  46. Weaver TE, Grunstein RR. Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proc Am Thorac Soci. 2008;5:173–8.

    Article  Google Scholar 

  47. • Skirko JR, James KT, Shusterman DJ, Weaver EM. Association of allergic rhinitis with change in nasal congestion in new continuous positive airway pressure users. JAMA Otolaryngol Head Neck Surg. 2020;146(6):1–7. New CPAP users face a daunting task to accommodate to OSA’s first line therapy. Clinicians may impact success for patients when AR is considered and treated at the initiation of CPAP therapy.

  48. • Camacho M, Riaz M, Capasso R, Ruoff CM, Guilleminault C, Kushida CA, Certal V. The effect of nasal surgery on continuous positive airway pressure device use and therapeutic treatment pressures: a systematic review and meta-analysis. Sleep. 2015 Feb 1;38(2):279–86. Surgical management of deficiencies in a patient’s upper airway play a significant adjunct role for successful OSA treatment with CPAP.

  49. Allergies and sleep apnea: How are they connected?. Resmed. https://www.resmed.com/en-us/sleep-apnea/sleep-blog/allergies-and-sleep-apnea-how-are-they-connected/. Accessed 24 Nov 2021.

  50. Yang Q, Li H, Wu W, Huang X, Tu B, Ma Y, Deng H, Li M, He H, Li C, Yang Y. Effect of continuous positive airway pressure on allergic rhinitis in patients with obstructive sleep apnea–hypopnea syndrome. Therapeutics and Clinical Risk Management. 2018;14:1507–13.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Douglas Dawson.

Ethics declarations

Conflict of Interest

Alpen Patel reports: Past President of American Academy of Otolaryngic Allergy. The other authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical collection on Otolaryngic Allergy

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Dawson, D., Patterson, M., Patel, A. et al. Where does Allergy Management Fit in Obstructive Sleep Apnea?. Curr Otorhinolaryngol Rep 10, 285–290 (2022). https://doi.org/10.1007/s40136-022-00405-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40136-022-00405-6

Keywords

  • Allergies
  • Allergic Rhinitis
  • Sleep
  • Obstructive Sleep Apnea
  • Medical and Surgical Therapy