Question

• In children with known history of allergic rhinitis and poor sleep, do inhaled nasal steroids, as compared to placebo improve the quality of sleep and lead to less daytime somnolence and therefore better quality of life?

Clinical Bottom Lines

1. A common complaint among patients with perennial allergic rhinitis is daytime somnolence and fatigue.
2. Daytime somnolence may be secondary to sleep disturbances because of nasal congestion.
3. Congestion associated with rhinitis may increase arousals and therefore decrease the quality of sleep.

Summary of Key Evidence

1. 32 Subjects (18-55) with perennial allergic rhinitis were randomized in an eight-week double blinded cross-over fashion to received placebo or fluticasone.¹
2. Subjects completed questionnaires, kept daily diaries and underwent sleep studies.
3. The study showed that while fluticasone improved subjective sleep when compared to placebo, there was no statistical difference in objective sleep studies.
4. Validity of study: While the study was designed with good validity, the study was underpowered to detect important differences.

Additional Comments

• One of the pitfalls of the study could have been the dose of fluticasone. It may be necessary to be on a higher dose to affect objective measured sleep.
• More research needs to be done before it can be concluded that congestion alone is the reason for disturbed sleep and decreased quality of sleep.

Citation

1. Craig TJ, Mende C. The effect of topical nasal fluticasone on objective sleep testing and the symptoms of rhinitis, sleep, and daytime somnolence in perennial allergic rhinitis. Allergy and Asthma Proc 2003; 24:53-58.

CAT Author: Darlene Kassab, MD

CAT Appraisers: Ken Pituch, MD

Date appraised: February 23, 2005