Role of the Allergist-Immunologist and Upper Airway Allergy in Sleep-Disordered Breathing

J Allergy Clin Immunol Pract. May-Jun 2017;5(3):628-639. doi: 10.1016/j.jaip.2016.10.007. Epub 2016 Dec 5.

Abstract

Background: Sleep-disordered breathing in general and obstructive sleep apnea in particular are commonly encountered conditions in allergy practice. Physiologically, nasal (or nasopharyngeal) obstruction from rhinitis, nasal polyposis, or adenotonsillar hypertrophy are credible contributors to snoring and nocturnal respiratory obstructive events. Nevertheless, existing practice parameters largely relegate the role of the allergist to adjunctive treatment in cases of continuous positive airway pressure intolerance.

Objectives: To survey active American Academy of Allergy, Asthma & Immunology members regarding their perceptions and practices concerning sleep-disordered breathing in adult and pediatric patients with rhinitis, and to review the medical literature concerning this connection to identify therapeutic implications and research gaps.

Methods: Members of the Work Group on Rhinitis and Sleep-disordered Breathing composed and distributed a Web-based clinically oriented survey to active American Academy of Allergy, Asthma & Immunology members in mid-2015. The group, in addition, conducted an English-language literature review using PubMed and other sources.

Results: Survey results were returned by 339 of 4881 active members (7%). More than two-third of respondents routinely asked about sleep problems, believed that sleep-disordered breathing was a problem for at least a "substantial minority" (10%-30%) of their adult patients, and believed that medical therapy for upper airway inflammatory conditions could potentially help ameliorate sleep-related complaints. Literature review supported the connection between high-grade nasal congestion/adenotonsillar hypertrophy and obstructive sleep apnea, and at least in the case of pediatric patients, supported the use of anti-inflammatory medication in the initial management of obstructive sleep apnea of mild-to-moderate severity.

Conclusions: Clinical allergy practice and the medical literature support a proactive role for allergists in the diagnosis and management of sleep-disordered breathing.

Keywords: Adenotonsillar hypertrophy; Adults; Allergic rhinitis; CPAP; Children; Epidemiology; Nasal polyposis; Obstructive sleep apnea; Pathophysiology; Sleep-disordered breathing; Therapy.

Publication types

  • Review

MeSH terms

  • Allergists*
  • Allergy and Immunology
  • Anti-Inflammatory Agents / therapeutic use
  • Humans
  • Hypersensitivity / diagnosis*
  • Hypersensitivity / drug therapy
  • Physician's Role
  • Practice Guidelines as Topic
  • Sleep Apnea, Obstructive / diagnosis*
  • Sleep Apnea, Obstructive / drug therapy

Substances

  • Anti-Inflammatory Agents