ASSOCIATION BETWEEN ALLERGIC RHINITIS AND SLEEP APNEA: A CROSS-SECTIONAL ANALYSIS OF SLEEP QUALITY

Abstract

Objective: To evaluate the association between allergic rhinitis (AR) and obstructive sleep apnea (OSA) severity and their combined impact on sleep quality in a cross-sectional adult cohort. Methods: Between January and June 2024, 300 consecutive patients (mean age 45.2 ± 12.1 years; 54% male) presenting for sleep evaluation underwent standardized AR assessment (ARIA criteria, Total Nasal Symptom Score), full‐night attended polysomnography (apnea–hypopnea index [AHI], arousal index, sleep efficiency), and subjective sleep measures (Pittsburgh Sleep Quality Index [PSQI], Epworth Sleepiness Scale [ESS]). Nasal nitric oxide and peripheral eosinophil counts were obtained to quantify allergic inflammation. Multivariable linear and logistic regressions adjusted for age, sex, BMI, and smoking status. Results: AR was present in 160 participants (53.3%). Compared to non‐AR individuals, those with AR exhibited significantly higher mean AHI (15.3 ± 8.6 vs. 9.8 ± 6.4 events/hour; p < 0.001), worse PSQI scores (8.2 ± 3.1 vs. 5.6 ± 2.4; p < 0.001), and greater daytime sleepiness (ESS 11.5 ± 4.2 vs. 7.4 ± 3.3; p < 0.001). AR symptom severity independently predicted increased AHI (β = 0.34; p = 0.002), PSQI (β = 0.29; p = 0.001), and ESS (β = 0.25; p = 0.003). Persistent AR phenotype demonstrated higher nasal nitric oxide (340 ± 60 vs. 220 ± 45 ppb) and eosinophil counts (780 ± 200 vs. 450 ± 120 cells/µL) than intermittent AR (both p < 0.001). Conclusions: AR significantly exacerbates OSA severity and subjective sleep disturbances, with biomarker levels indicating a dose–response relationship. These findings support routine AR screening in sleep clinics and integrated management strategies to improve patient outcomes.