Patients with
allergic rhinitis frequently present with symptoms of nasal congestion,
runny nose,
sneezing,
daytime somnolence and
fatigue associated with decreased cognitive performance and impaired quality of life. Recent research has suggested that
daytime somnolence in
allergic rhinitis can be attributed to chronic
inflammation of the nasal mucosa leading to nasal congestion and obstructed nasal passageways resulting in disturbed sleep. Treating
daytime somnolence due to
allergic rhinitis requires a reduction in obstruction caused by nasal congestion. Currently available
therapy for
allergic rhinitis includes topical
corticosteroids, sedating and nonsedating
antihistamines, topical
cromolyn sodium (
sodium cromoglycate),
decongestants,
immunotherapy and topical
ipratropium bromide. The effectiveness of
antihistamines in patients with
allergic rhinitis has long been established. However, results of placebo-controlled trials investigating the effects of
azelastine on sleep and
daytime somnolence have produced conflicting results. Sleep improved with
azelastine therapy, but there was a lack of evidence that
azelastine significantly affected
daytime sleepiness, sleep severity and nasal congestion.
Sedating antihistamines exacerbate
daytime somnolence and should be avoided in patients with
allergic rhinitis. In a separate study,
desloratadine failed to benefit sleep, but did not worsen
daytime somnolence. Topical nasal
cromolyn sodium is inconvenient to use and is unlikely to have a major effect on nasal congestion.
Decongestants do decrease nasal congestion but the effect this has on sleep has not been adequately studied. Recent research has shown that topical
corticosteroids are an effective treatment for alleviating nasal congestion secondary to
allergic rhinitis. However, few studies have assessed the effect of topical
corticosteroids on daytime
fatigue and sleep. In 20 patients with
allergic rhinitis and symptoms of
daytime sleepiness,
flunisolide significantly improved sleep quality and congestion but
daytime sleepiness was not significantly improved. A similar study with
fluticasone propionate showed improvement in nasal congestion and sleep but there was no significant change in objective sleep measurements recorded on polysomnography. Further research involving objective measures of sleep quality is necessary to determine the efficacy of medications in the treatment of
allergic rhinitis associated with
fatigue and
daytime somnolence.