Patients with allergic rhinitis complain of daytime sleepiness, fatigue, and have been found to have decreased cognitive performance.  The proposed mechanism for this has been that nasal congestion causes airway resistance or mouth breathing while asleep.  This leads to the pharynx collapsing during breathing and intermittent obstruction.  Children with seasonal allergic rhinitis do not have multiple arousals during those nights that are off-season for allergies.

Fourteen children (ages 4-9 years) with perennial allergic rhinitis (confirmed with allergy prick test) were studied.  Those with severe asthma or recent use of nasally-inhaled steroids were excluded.   Parents completed a “Rhinitis Quality of Life Questionnaire”.  Arrangements were made to have an overnight polysomnograph (a sleep study) performed at the child’s home.  Beginning the next day, budesonide (also known as Rhinocort) was begun at 2 sprays in each nostril every morning.  An examination and the questionnaire were given 2, 4, and 6 weeks after starting the medication.  And at 6 weeks, another polysomnograph was done. 

Prior to beginning the medication, the mean number of sleep arousals was 8.4 per hour.  After 6 weeks of medication, the mean number dropped to only 1.2 per hour.  The change in arousals was mostly for reduction in hypopneic events.  Parents’ responses on the questionnaire also demonstrated fewer rhinitis symptoms and better daytime quality of life with the medication.

(Mansfield LE, et al.  Ann Allergy Asthma Immunol 2004; 92:240-244)

Comment:  Intranasal steroids have also been reported to improve sleep disordered breathing in children with enlarged tonsils and adenoids.  Other articles I’ve abstracted for School Health Alert have shown very marked effects of poor sleep on cognitive skills and school achievement.  It’s heartening to know that a medication can be very effective to help these students.   – H.T.