Generic placeholder image

Current Respiratory Medicine Reviews

Editor-in-Chief

ISSN (Print): 1573-398X
ISSN (Online): 1875-6387

Review Article

The Association Between Obstructive Sleep Apnea and Allergic Rhinitis: Current Literature Review

Author(s): Shi Nee Tan* and Baharudin Abdullah

Volume 17, Issue 1, 2021

Published on: 04 March, 2021

Page: [13 - 19] Pages: 7

DOI: 10.2174/1573398X17666210304100358

Price: $65

Abstract

Sleep-disordered breathing (SDB) is now a significant health problem in today's culture. It ranges from a spectrum of abnormal conditions during sleep from the primary snorer to mild, moderate, or severe obstructive sleep apnea (OSA). SDB also comprises other conditions, such as sleep-related hypoventilation, sleep-related hypoxemia, and central sleep apnea syndromes.

One of the components of the pathophysiology of OSA that remain unclear is the association of allergic rhinitis (AR) in the evolution of OSA. Several studies relate the co-existence of OSA and AR in the common clinical practice, but its correlation was not clear. This review article aimed to review the pathophysiological relationship between OSA and AR in terms of the role of chemical mediators and the effect of AR treatment in support of OSA.

The symptoms of AR further accelerate the clinical progression to OSA development. Inflammatory mediators such as histamine, cysteinyl leukotrienes, and interleukins are found at a high level in AR, which can aggravate AR symptoms such as nasal obstruction, rhinorrhea, and itchiness, which can then lead to sleep disruption in OSA patients. In addition, OSA patients also have increased chemical mediators such as tumor necrosis factor, interleukin 6, and 1, which would activate the T helper 2 phenotypes that can aggravate AR symptoms. This vicious cycle can potentiate each other and worsen the condition. Few studies have shown that treatment of AR can improve OSA, especially the use of intranasal steroid and leukotriene receptor antagonists.

A detailed evaluation of rhinitis symptoms should be made for OSA patients so that they can benefit not only from the improvement of AR but also the good sleep quality.

Keywords: Sleep apnea, obstructive, rhinitis, allergic, pathophysiology, sleep-disordered breathing (SDB).

Graphical Abstract

[1]
Benjafield AV, Ayas NT, Eastwood PR, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med 2019; 7(8): 687-98.
[http://dx.doi.org/10.1016/S2213-2600(19)30198-5] [PMID: 31300334]
[2]
Lyons MM, Bhatt NY, Pack AI, Magalang UJ. Global burden of sleep-disordered breathing and its implications. Respirology 2020; 25(7): 690-702.
[http://dx.doi.org/10.1111/resp.13838] [PMID: 32436658]
[3]
Appleton SL, Gill TK, Lang CJ, et al. Prevalence and comorbidity of sleep conditions in Australian adults: 2016 Sleep Health Foundation national survey. Sleep Health 2018; 4(1): 13-9.
[http://dx.doi.org/10.1016/j.sleh.2017.10.006] [PMID: 29332673]
[4]
Chiang CL, Chen YT, Wang KL, et al. Comorbidities and risk of mortality in patients with sleep apnea. Ann Med 2017; 49(5): 377-83.
[http://dx.doi.org/10.1080/07853890.2017.1282167] [PMID: 28276869]
[5]
Maspero C, Giannini L, Galbiati G, Rosso G, Farronato G. Obstructive sleep apnea syndrome: a literature review. Minerva Stomatol 2015; 64(2): 97-109.
[PMID: 25747430]
[6]
Ye L, Pien GW, Ratcliffe SJ, et al. The different clinical faces of obstructive sleep apnoea: a cluster analysis. Eur Respir J 2014; 44(6): 1600-7.
[http://dx.doi.org/10.1183/09031936.00032314] [PMID: 25186268]
[7]
Motamedi KK, McClary AC, Amedee RG. Obstructive sleep apnea: a growing problem. Ochsner J 2009; 9(3): 149-53.
[PMID: 21603432]
[8]
Knauert M, Naik S, Gillespie MB, Kryger M. Clinical consequences and economic costs of untreated obstructive sleep apnea syndrome. World J Otorhinolaryngol Head Neck Surg 2015; 1(1): 17-27.
[http://dx.doi.org/10.1016/j.wjorl.2015.08.001] [PMID: 29204536]
[9]
Hellings PW, Klimek L, Cingi C, et al. Non-allergic rhinitis: Position paper of the European Academy of Allergy and Clinical Immunology. Allergy 2017; 72(11): 1657-65.
[http://dx.doi.org/10.1111/all.13200] [PMID: 28474799]
[10]
Kakli HA, Riley TD. Allergic Rhinitis. Prim Care 2016; 43(3): 465-75.
[http://dx.doi.org/10.1016/j.pop.2016.04.009] [PMID: 27545735]
[11]
Lorenz A, Küster I, Beule AG. Non-allergic Rhinitis: epidemiology, diagnostic and therapy. Laryngorhinootologie 2015; 94(12): 847-60.
[http://dx.doi.org/10.1055/s-0041-107489] [PMID: 26669462]
[12]
Zheng M, Wang X, Ge S, et al. 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.
[http://dx.doi.org/10.5664/jcsm.6694] [PMID: 28633721]
[13]
Cao Y, Wu S, Zhang L, Yang Y, Cao S, Li Q. Association of allergic rhinitis with obstructive sleep apnea: A meta-analysis. Medicine (Baltimore) 2018; 97(51): e13783.
[http://dx.doi.org/10.1097/MD.0000000000013783] [PMID: 30572534]
[14]
Chirakalwasan N, Ruxrungtham K. The linkage of allergic rhinitis and obstructive sleep apnea. Asian Pac J Allergy Immunol 2014; 32(4): 276-86.
[PMID: 25543037]
[15]
Pasha S, Kumar S, Chatterjee AB, Krishnaswamy G. An obstructive sleep apnea primer: What the practicing allergist needs to know. Ann Allergy Asthma Immunol 2017; 118(3): 259-68.
[http://dx.doi.org/10.1016/j.anai.2016.07.033] [PMID: 28284532]
[16]
Shusterman D, Baroody FM, Craig T, Friedlander S, Nsouli T, Silverman B. Role of the allergist-immunologist and upper airway allergy in sleep-disordered breathing. J Allergy Clin Immunol Pract 2017; 5(3): 628-39.
[http://dx.doi.org/10.1016/j.jaip.2016.10.007] [PMID: 27923646]
[17]
Eckert DJ. Phenotypic approaches to obstructive sleep apnea - New pathways for targeted therapy. Sleep Med Rev 2018; 37: 45-59.
[http://dx.doi.org/10.1016/j.smrv.2016.12.003] [PMID: 28110857]
[18]
Eckert DJ, White DP, Jordan AS, Malhotra A, Wellman A. Defining phenotypic causes of obstructive sleep apnea. Identification of novel therapeutic targets. Am J Respir Crit Care Med 2013; 188(8): 996-1004.
[http://dx.doi.org/10.1164/rccm.201303-0448OC] [PMID: 23721582]
[19]
Zinchuk A, Yaggi HK. Phenotypic Subtypes of OSA: A challenge and opportunity for precision medicine. Chest 2020; 157(2): 403-20.
[http://dx.doi.org/10.1016/j.chest.2019.09.002] [PMID: 31539538]
[20]
Zinchuk AV, Gentry MJ, Concato J, Yaggi HK. Phenotypes in obstructive sleep apnea: A definition, examples and evolution of approaches. Sleep Med Rev 2017; 35: 113-23.
[http://dx.doi.org/10.1016/j.smrv.2016.10.002] [PMID: 27815038]
[21]
Subramani Y, Singh M, Wong J, Kushida CA, Malhotra A, Chung F. Understanding phenotypes of obstructive sleep apnea: Applications in anesthesia, surgery, and perioperative medicine. Anesth Analg 2017; 124(1): 179-91.
[http://dx.doi.org/10.1213/ANE.0000000000001546] [PMID: 27861433]
[22]
Gray EL, McKenzie DK, Eckert DJ. Obstructive sleep apnea without obesity is common and difficult to treat: Evidence for a distinct pathophysiological phenotype. J Clin Sleep Med 2017; 13(1): 81-8.
[http://dx.doi.org/10.5664/jcsm.6394] [PMID: 27655455]
[23]
Arnardottir ES, Bjornsdottir E, Olafsdottir KA, Benediktsdottir B, Gislason T. Obstructive sleep apnoea in the general population: highly prevalent but minimal symptoms. Eur Respir J 2016; 47(1): 194-202.
[http://dx.doi.org/10.1183/13993003.01148-2015] [PMID: 26541533]
[24]
Billings ME, Rosen CL, Auckley D, et al. Psychometric performance and responsiveness of the functional outcomes of sleep questionnaire and sleep apnea quality of life instrument in a randomized trial: the HomePAP study. Sleep (Basel) 2014; 37(12): 2017-24.
[http://dx.doi.org/10.5665/sleep.4262] [PMID: 25325491]
[25]
Edwards BA, Eckert DJ, McSharry DG, et al. Clinical predictors of the respiratory arousal threshold in patients with obstructive sleep apnea. Am J Respir Crit Care Med 2014; 190(11): 1293-300.
[http://dx.doi.org/10.1164/rccm.201404-0718OC] [PMID: 25321848]
[26]
Edwards BA, Redline S, Sands SA, Owens RL. More than the sum of the respiratory events: Personalized medicine approaches for obstructive sleep apnea. Am J Respir Crit Care Med 2019; 200(6): 691-703.
[http://dx.doi.org/10.1164/rccm.201901-0014TR] [PMID: 31022356]
[27]
El-Ad B, Lavie P. Effect of sleep apnea on cognition and mood. Int Rev Psychiatry 2005; 17(4): 277-82.
[http://dx.doi.org/10.1080/09540260500104508] [PMID: 16194800]
[28]
Mateika JH, Panza G, Alex R, El-Chami M. The impact of intermittent or sustained carbon dioxide on intermittent hypoxia initiated respiratory plasticity. What is the effect of these combined stimuli on apnea severity? Respir Physiol Neurobiol 2018; 256: 58-66.
[http://dx.doi.org/10.1016/j.resp.2017.10.008] [PMID: 29097171]
[29]
Ruel G, Martin SA, Lévesque JF, et al. Association between multimorbidity and undiagnosed obstructive sleep apnea severity and their impact on quality of life in men over 40 years old. Glob Health Epidemiol Genom 2018; 3: e10.
[http://dx.doi.org/10.1017/gheg.2018.9] [PMID: 30263134]
[30]
Magliulo G, Iannella G, Ciofalo A, et al. Nasal pathologies in patients with obstructive sleep apnoea. Acta Otorhinolaryngol Ital 2019; 39(4): 250-6.
[http://dx.doi.org/10.14639/0392-100X-2173] [PMID: 30933181]
[31]
Wilhelm CP, deShazo RD, Tamanna S, Ullah MI, Skipworth LB. The nose, upper airway, and obstructive sleep apnea. Ann Allergy Asthma Immunol 2015; 115(2): 96-102.
[http://dx.doi.org/10.1016/j.anai.2015.06.011] [PMID: 26250769]
[32]
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.
[http://dx.doi.org/10.1016/S0091-6749(97)70124-6] [PMID: 9042068]
[33]
Craig TJ, McCann JL, Gurevich F, Davies MJ. The correlation between allergic rhinitis and sleep disturbance. J Allergy Clin Immunol 2004; 114(5)(Suppl.): S139-45.
[http://dx.doi.org/10.1016/j.jaci.2004.08.044] [PMID: 15536445]
[34]
Kim SH, Won HK, Moon SD, et al. Impact of self-reported symptoms of allergic rhinitis and asthma on sleep disordered breathing and sleep disturbances in the elderly with polysomnography study. PLoS One 2017; 12(2): e0173075.
[http://dx.doi.org/10.1371/journal.pone.0173075] [PMID: 28245272]
[35]
Tashiro M, Mochizuki H, Iwabuchi K, et al. Roles of histamine in regulation of arousal and cognition: functional neuroimaging of histamine H1 receptors in human brain. Life Sci 2002; 72(4-5): 409-14.
[http://dx.doi.org/10.1016/S0024-3205(02)02276-2] [PMID: 12467881]
[36]
Meltzer EO. Role for cysteinyl leukotriene receptor antagonist therapy in asthma and their potential role in allergic rhinitis based on the concept of “one linked airway disease”. Ann Allergy Asthma Immunol 2000; 84(2): 176-85.
[http://dx.doi.org/10.1016/S1081-1206(10)62750-0] [PMID: 10719774]
[37]
Philip G, Malmstrom K, Hampel FC, et al. Montelukast for treating seasonal allergic rhinitis: a randomized, double-blind, placebo-controlled trial performed in the spring. Clin Exp Allergy 2002; 32(7): 1020-8.
[http://dx.doi.org/10.1046/j.1365-2222.2002.01422.x] [PMID: 12100048]
[38]
Krouse HJ, Davis JE, Krouse JH. Immune mediators in allergic rhinitis and sleep. Otolaryngol Head Neck Surg 2002; 126(6): 607-13.
[http://dx.doi.org/10.1067/mhn.2002.125300] [PMID: 12087326]
[39]
Mullington JM, Hinze-Selch D, Pollmächer T. Mediators of inflammation and their interaction with sleep: relevance for chronic fatigue syndrome and related conditions. Ann N Y Acad Sci 2001; 933: 201-10.
[http://dx.doi.org/10.1111/j.1749-6632.2001.tb05825.x] [PMID: 12000021]
[40]
Lofaso F, Coste A, d’Ortho MP, et al. Nasal obstruction as a risk factor for sleep apnea syndrome. Eur Respir J 2000; 16(4): 639-43.
[http://dx.doi.org/10.1034/j.1399-3003.2000.16d12.x] [PMID: 11106205]
[41]
Scadding G. Non-surgical treatment of adenoidal hypertrophy: the role of treating IgE-mediated inflammation. Pediatr Allergy Immunol 2010; 21(8): 1095-106.
[http://dx.doi.org/10.1111/j.1399-3038.2010.01012.x] [PMID: 20609137]
[42]
Ishman SL, Smith DF, Benke JR, Nguyen MT, Lin SY. The prevalence of sleepiness and the risk of sleep-disordered breathing in children with positive allergy test. Int Forum Allergy Rhinol 2012; 2(2): 139-43.
[http://dx.doi.org/10.1002/alr.20104] [PMID: 22162486]
[43]
Kimple AJ, Ishman SL. Allergy and sleep-disordered breathing. Curr Opin Otolaryngol Head Neck Surg 2013; 21(3): 277-81.
[http://dx.doi.org/10.1097/MOO.0b013e32835ff132] [PMID: 23619424]
[44]
Poirrier A-L, Eloy P, Rombaux P. Nose and sleep breathing disorders.Nasal physiology and pathophysiology of nasal disorders. Springer 2013; pp. 293-311.
[http://dx.doi.org/10.1007/978-3-642-37250-6_23]
[45]
Williams R, Patel V, Chen YF, et al. The upper airway nasal complex: Structural contribution to persistent nasal obstruction. Otolaryngol Head Neck Surg 2019; 161(1): 171-7.
[http://dx.doi.org/10.1177/0194599819838262] [PMID: 30909809]
[46]
Dempsey JA, Veasey SC, Morgan BJ, O’Donnell CP. Pathophysiology of sleep apnea. Physiol Rev 2010; 90(1): 47-112.
[http://dx.doi.org/10.1152/physrev.00043.2008] [PMID: 20086074]
[47]
Fitzpatrick MF, McLean H, Urton AM, Tan A, O’Donnell D, Driver HS. Effect of nasal or oral breathing route on upper airway resistance during sleep. Eur Respir J 2003; 22(5): 827-32.
[http://dx.doi.org/10.1183/09031936.03.00047903] [PMID: 14621092]
[48]
Georgalas C. The role of the nose in snoring and obstructive sleep apnea: An update. Eur Arch Otorhinolaryngol 2011; 268(9): 1365-73.
[http://dx.doi.org/10.1007/s00405-010-1469-7] [PMID: 21340561]
[49]
Kohler M, Bloch KE, Stradling JR. The role of the nose in the pathogenesis of obstructive sleep apnea and snoring. Eur Respir J 2007; 30(6): 1208-15.
[http://dx.doi.org/10.1183/09031936.00032007] [PMID: 18055705]
[50]
McNicholas W. The nose and OSA: Variable nasal obstruction may be more important in pathophysiology than fixed obstruction. Eur Respiratory Soc 2008.
[51]
Kemaloğlu YK. Relationship between chronic nasal obstruction and craniofacial growth. Int J Pediatr Otorhinolaryngol 1999; 51(1): 57-9.
[PMID: 10622448]
[52]
Occasi F, Perri L, Saccucci M, et al. Malocclusion and rhinitis in children: An easy-going relationship or a yet to be resolved paradox? A systematic literature revision. Ital J Pediatr 2018; 44(1): 100.
[http://dx.doi.org/10.1186/s13052-018-0537-2] [PMID: 30134958]
[53]
Badran M, Golbidi S, Ayas N, Laher I. Nitric oxide bioavailability in obstructive sleep apnea: Interplay of asymmetric dimethylarginine and free radicals. Sleep disorders 2015.
[http://dx.doi.org/10.1155/2015/387801]
[54]
Michels DdS, Rodrigues AdMS, Sampaio ALL, Venosa AR. Nasal involvement in obstructive sleep apnea syndrome. Int J Otolaryngol 2014; 2014: 717419.
[55]
Magliulo G, De Vincentiis M, Iannella G, et al. Olfactory evaluation in obstructive sleep apnea patients. Acta Otorhinolaryngol Ital 2018; 38(4): 338-45.
[PMID: 30197425]
[56]
Meltzer EO, Blaiss MS, Derebery MJ, et al. Burden of allergic rhinitis: Results from the pediatric allergies in America survey. J Allergy Clin Immunol 2009; 124(3)(Suppl.): S43-70.
[http://dx.doi.org/10.1016/j.jaci.2009.05.013] [PMID: 19592081]
[57]
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.
[PMID: 14694248]
[58]
Hughes K, Glass C, Ripchinski M, et al. Efficacy of the topical nasal steroid budesonide on improving sleep and daytime somnolence in patients with perennial allergic rhinitis. Allergy 2003; 58(5): 380-5.
[http://dx.doi.org/10.1034/j.1398-9995.2003.00093.x] [PMID: 12797340]
[59]
Gurevich F, Glass C, Davies M, et al. The effect of intranasal steroid budesonide on the congestion-related sleep disturbance and daytime somnolence in patients with perennial allergic rhinitis. Allergy Asthma Proc 2005; 26(4): 268-74.
[PMID: 16270719]
[60]
Chohan A, Lal A, Chohan K, Chakravarti A, Gomber S. Systematic review and meta-analysis of randomized controlled trials on the role of mometasone in adenoid hypertrophy in children. Int J Pediatr Otorhinolaryngol 2015; 79(10): 1599-608.
[http://dx.doi.org/10.1016/j.ijporl.2015.07.009] [PMID: 26235732]
[61]
Zhang L, Mendoza-Sassi RA, César JA, Chadha NK. Intranasal corticosteroids for nasal airway obstruction in children with moderate to severe adenoidal hypertrophy. Cochrane Database Syst Rev 2008; (3): CD006286.
[http://dx.doi.org/10.1002/14651858.CD006286.pub2] [PMID: 18646145]
[62]
Goldbart AD, Goldman JL, Veling MC, Gozal D. Leukotriene modifier therapy for mild sleep-disordered breathing in children. Am J Respir Crit Care Med 2005; 172(3): 364-70.
[http://dx.doi.org/10.1164/rccm.200408-1064OC] [PMID: 15879419]
[63]
Goldbart AD, Greenberg-Dotan S, Tal A. Montelukast for children with obstructive sleep apnea: A double-blind, placebo-controlled study. Pediatrics 2012; 130(3): e575-80.
[http://dx.doi.org/10.1542/peds.2012-0310] [PMID: 22869829]
[64]
Kheirandish L, Goldbart AD, Gozal D. Intranasal steroids and oral leukotriene modifier therapy in residual sleep-disordered breathing after tonsillectomy and adenoidectomy in children. Pediatrics 2006; 117(1): e61-6.
[http://dx.doi.org/10.1542/peds.2005-0795] [PMID: 16396849]
[65]
Kerr P, Millar T, Buckle P, Kryger M. The importance of nasal resistance in obstructive sleep apnea syndrome. J Otolaryngol 1992; 21(3): 189-95.
[PMID: 1404570]
[66]
Clarenbach CF, Kohler M, Senn O, Thurnheer R, Bloch KE. Does nasal decongestion improve obstructive sleep apnea? J Sleep Res 2008; 17(4): 444-9.
[http://dx.doi.org/10.1111/j.1365-2869.2008.00667.x] [PMID: 18710420]
[67]
McLean HA, Urton AM, Driver HS, et al. Effect of treating severe nasal obstruction on the severity of obstructive sleep apnea. Eur Respir J 2005; 25(3): 521-7.
[http://dx.doi.org/10.1183/09031936.05.00045004] [PMID: 15738298]
[68]
Braver HM, Block AJ. Effect of nasal spray, positional therapy, and the combination thereof in the asymptomatic snorer. Sleep 1994; 17(6): 516-21.
[http://dx.doi.org/10.1093/sleep/17.6.516] [PMID: 7528939]
[69]
Cox DR, Wise SK. Medical treatment of nasal airway obstruction. Otolaryngol Clin North Am 2018; 51(5): 897-908.
[http://dx.doi.org/10.1016/j.otc.2018.05.004] [PMID: 29914725]
[70]
Morgenthaler TI, Kapen S, Lee-Chiong T, et al. Practice parameters for the medical therapy of obstructive sleep apnea. Sleep 2006; 29(8): 1031-5.
[http://dx.doi.org/10.1093/sleep/29.8.1031] [PMID: 16944671]
[71]
Veasey SC, Guilleminault C, Strohl KP, Sanders MH, Ballard RD, Magalang UJ. Medical therapy for obstructive sleep apnea: A review by the medical therapy for obstructive sleep apnea task force of the standards of practice committee of the American academy of sleep medicine. Sleep 2006; 29(8): 1036-44.
[http://dx.doi.org/10.1093/sleep/29.8.1036] [PMID: 16944672]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy