The first day of June is the meteorological start of summer. As a moderately wet spring slowly blurs to (a damp UK) summer, we can look forward to holidays in the countryside, enjoying the changing pollen seasons from tree to grass. Timely then, that the Editors’ Choice this issue shows that sleep impairment is found in over 60% of patients with allergic rhinitis and is associated with an increased risk of OSA. Accordingly, patients with allergic rhinitis with moderate-to-severe sleep impairment should be considered for sleep disorder evaluation. With this condition affecting so many, it provides food for thought across many of us in practice. Time to stock up on antihistamines! As ever, we would like to thank our reviewers for their contributions.
Nazia and Hannah
This is an interesting article addressing allergic rhinitis (AR) with resultant sleep impairment, which is found in over 60% of patients. The pathophysiology is multifactorial and includes vascular dilatation and decreased REM sleep, likely due to the release of cysteinyl leukotrienes, histamine, inflammatory cytokines, etc. following an allergic reaction. This group of patients has increased risk of OSA, possibly due to AR obstruction inhibiting nasal receptors and increasing airflow resistance. The authors recommend that, given its high prevalence and morbidity, patients with AR with moderate-to-severe sleep impairment should be considered for sleep disorder evaluation. Given often normal AHI and RDI in this group of patients, they do recommend that, if evaluated by PSG, special consideration should be given to REM-RDI and respiratory effort-related arousals. Effective therapies include the usual step ladder treatment, including INCS, non-CNS-penetrating antihistamines, and immunotherapy. In addition, inferior turbinate reduction strategies may improve sleep quality in cases of concomitant AR. Overall, we feel that the article is well written and makes a good read for most practising otolaryngologists.
