Reviews and feature articleSleep and allergic disease: A summary of the literature and future directions for research
Section snippets
Effect of allergic disease on sleep: Pathophysiologic mechanisms
A large area of focus on sleep quality in patients with allergic diseases involves pathophysiologic mechanisms related to illness that might influence symptoms that can disrupt the sleep process. To briefly summarize, asthma and AR symptoms are frequently experienced during nighttime hours because of many factors, including a dip in cortisol levels at night that affects inflammatory cytokines and other mediators.21 In addition, nighttime disturbances, such as airway obstruction in patients with
Nonadherence to treatment
If patients with allergic disease do not adhere to treatment recommendations for medication use, whether it be daily use of topical corticosteroids30 or controller asthma medications31 or avoid using rescue medication, this can result in increased symptoms during the nighttime hours and disrupted sleep. Thus, the importance of consistent medication use is crucial for high-quality sleep in patients with atopic diseases. Poor trigger control associated with AR and asthma in the home environment
Sleep disruption: Asthma
Results from a few cross-sectional studies indicate that atopic diseases, such as asthma, can affect sleep quality through the disruption of sleep, likely in part because of the presence of nocturnal symptoms.33 In one study including children with asthma, data from 1 night of polysomnography indicated that the primary sleep abnormality associated with nocturnal asthma symptoms is interruption in the continuity of sleep by frequent awakenings.34 These sleep disruptions caused by nighttime
Future directions for research
The current literature on sleep and allergic disease supports many of the proposed associations depicted in our conceptual model (Fig 1). Some areas have received more attention than others. For example, much is known about the pathophysiologic mechanisms that contribute to allergic symptoms that occur during the night and might disrupt sleep in patients with allergic diseases. Although studies have furthered our understanding of the effect of these conditions on sleep quality, there are many
Conclusions
In summary, sleep impairment associated with allergic diseases, such as asthma, AR, and AD, can have a significant effect on the patient's quality of life and functioning in specific areas. The sleep disturbance can be caused by congestion, symptoms of the underlying disease, and inflammatory cytokines and other mediators that can directly disturb sleep and cause daytime somnolence, fatigue, decreased cognitive and psychomotor abilities, and increased difficulty concentrating.91 More research
References (91)
- et al.
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
(1998) One airway, one disease
Chest
(1997)- et al.
Rhinitis symptoms and comorbidities in the United States: burden of rhinitis in America survey
Otolaryngol Head Neck Surg
(2008) - et al.
Validation of a standardized version of the Asthma Quality of Life Questionnaire
Chest
(1999) - et al.
Asthma disparities in the prevalence, morbidity and treatment of Latino children
Soc Sci Med
(2006) Management of sleep disturbance associated with atopic dermatitis
J Allergy Clin Immunol
(2006)Influences of allergic rhinitis on sleep
Otolaryngol Head Neck Surg
(2004)- et al.
The nose and sleep-disordered breathing: what we know and what we do not know
Chest
(2003) - et al.
Roles of histamine in regulation of arousal and cognition: functional neuroimaging of histamine H1 receptors in human brain
Life Sci
(2002) - et al.
Assessment of quality of life in adolescents with allergic rhinoconjunctivitis: development and testing of a questionnaire for clinical trials
J Allergy Clin Immunol
(1994)
Nocturnal awakening caused by asthma in childrenwith mild to moderate asthma in the childhood asthma management program
J Allergy Clin Immunol
Nocturnal asthma symptoms and poor sleep quality among urban school children with asthma
Acad Pediatr
Burden of allergic rhinitis: results from the Pediatric Allergies in America survey
J Allergy Clin Immunol
Nasal obstruction as a risk factor for sleep-disordered breathing. The University of Wisconsin Sleep and Respiratory Research Group
J Allergy Clin Immunol
Disease severity, scratching, and sleep quality in patients with atopic dermatitis
J Am Acad Dermatol
Sleep disturbance in persistent allergic rhinitis measured using actigraphy
Ann Allergy Asthma Immunol
Changes in daytime sleepiness, quality of life, and objective sleep patterns in seasonal allergic rhinitis: a controlled clinical trial
J Allergy Clin Immunol
A questionnaire to measure quality of life in adults with nocturnal allergic rhinoconjunctivitis
J Allergy Clin Immunol
Factors affecting sleep disturbances in children and adolescents
Sleep Med
Sleep disorders in patients with asthma, atopic dermatitis, and allergic rhinitis
J Allergy Clin Immunol
Actigraphy assessment of sleep disturbance in patients with atopic dermatitis: an objective life quality measure
J Allergy Clin Immunol
Symptoms related to obstructive sleep apnoea are common in subjects with asthma, chronic bronchitis and rhinitis in a general population
Respir Med
Sleep-disordered breathing is associated with asthma severity in children
J Pediatr
Allergic rhinitis as a risk factor for habitual snoring in children
Chest
High prevalence of allergic sensitization in children with habitual snoring and obstructive sleep apnea
Chest
Symptoms related to sleep-disordered breathing in white and Hispanic children
Chest
Cultural influences on the bedtime behaviors of young children
Sleep Med
Modifiable barriers to adherence to inhaled steroids among adults with asthna: it's not just black and white
J Clin Immunol
Rhinitis and sleep
Sleep Med Rev
Non-adherence with asthma therapy: more than just forgetting
J Pediatr
Effects of 48 hours sleep deprivation on human immune profile
Sleep Res Online
Effects of sleep deprivation, nicotine, and selenium on wound healing in rats
Int J Neurosci
Does sleep promote recovery after bone marrow transplantation?—a hypothesis
Pediatr Transplant
Centers for Disease Control and Prevention (CDC). Vital signs: asthma prevalence, disease characteristics, and self-management education: United States, 2001-2009
MMWR Morb Mortal Wkly Rep
The burden of allergic rhinitis
Allergy Asthma Proc
Guidelines for the diagnosis and management of asthma
Allergic rhinitis in childhood
Allergy
[Introduction to allergic rhinitis and its impact on asthma (ARIA) guidelines 2010 revision]
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi
2003 National sleep disorders research plan
Important aspects in management of allergic rhinitis: compliance, cost, and quality of life
Allergy Asthma Proc
Congestion and sleep impairment in allergic rhinitis
Asian Pac J Allergy Immunol
Sleep and allergic rhinitis
J Investig Allergol Clin Immunol
Nocturnal asthma in children affects school attendance, school performance and parents' work attendance
Arch Pediatr Adolesc Med
Heterogeneity of childhood asthma among Hispanic children: Puerto Rican children bear a disproportionate burden
Pediatrics
Multiple urban and asthma-related risks and their association with asthma morbidity in children
J Pediatr Psychol
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Supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01 HD057220 to D.K.M.).
Disclosure of potential conflict of interest: T. Craig is an Interest Section Leader for the American Academy of Allergy, Asthma & Immunology; is a board member for the American College of Allergy, Asthma & Immunology and the Joint Council of Allergy, Asthma & Immunology; has consultant arrangements with CSL Behring, Dyax, and Viropharma; has provided expert testimony in a case related to anaphylaxis; has received grants from Viropharma, CSL Behring, Shire, Dyax, Pharming, Forrest, Genentech, Merck, and GlaxoSmithKline; has received payment for lectures from Viropharma, CSL Behring, Dyax, Merck, Novartis, Shire, and Teva; and has received payment for development of educational presentations from the Vietnam Education Foundation. C. A. Esteban has received a grant from the National Institute of Child Health and Human Development. The rest of the authors declare that they have no relevant conflicts of interest.