Intranasal Corticosteroids Improve Sleep for Patients With Allergic Rhinitis

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Intranasal corticosteroids, commonly used to treat allergic rhinitis (AR), significantly improve sleep quality in patients suffering from AR. A systematic review and meta-analysis found that these medications, besides alleviating daytime symptoms like nasal congestion, also enhance sleep, addressing a key issue often overlooked in allergy management.

Common symptoms of AR, a condition that affects between 10% and 40% of the global population, include nasal congestion and rhinorrhea. Caused by an immunoglobulin E-mediated response to allergens in the environment — such as pollen, mold spores, dust mites and pet dander — AR significantly reduces a patient’s quality of life, including an increase in sleep disturbances. Although this impact is well known, the effects of intranasal corticosteroids on sleep have not been comprehensively investigated.

“Adequate sleep is essential for maintaining mood, cognitive function and the function of the endocrine and immune systems,” wrote a group of investigators led by Kenshiro Tabata, MD, associated with the Department of Biochemistry and Cellular Biology at the National Institute of Neuroscience, National Center of Neurology and Psychiatry in Tokyo, Japan. “In adolescents, sleep disturbances are associated with worsened symptom severity and the persistence of attention-deficit/hyperactivity disorder (ADHD) into adulthood. Addressing sleep quality and duration issues is crucial for the prevention of numerous health conditions, as research indicates that poor sleep and sleep disorders can lead to serious health issues, such as obesity, diabetes, hypertension and cardiovascular diseases, ultimately increasing the risk of mortality.”

To determine the impact intranasal corticosteroids have on sleep quality among patients with AR, investigators conducted a database search of PubMed, Cochrane Central Register of Controlled Trials and Ichushi-Web to identify relevant randomized controlled trials (RCTs). Trials involving a placebo group were eligible for inclusion. Sleep quality was measured by standardized questionnaires, the risk of bias was assessed, and meta-analyses were performed.

The review included 18 RCTs with more than 6,000 participants. All studies excluded patients with nasal disorders that could have impacted the efficacy evaluation, such as nasal surgery, nasal polyps, chronic rhinosinusitis, biopsy history or trauma. Most of the RCTs also excluded patients with asthma.

The meta-analysis included 12 comparisons from eight studies for the Rhinoconjunctivitis Quality of Life Questionnaire sleep domain. Results revealed intranasal corticosteroids effectively improved sleep-related quality of life measures. The Nocturnal Rhinoconjunctivitis Quality of Life Questionnaire also demonstrated improvements based on two comparisons from one study. However, the Epworth Sleepiness Scale did not result in significant improvements based on two comparisons from two studies. Significant improvements among patients with seasonal and perennial AR were observed based on subgroup analyses.

The findings further confirmed the current treatment guidelines for AR and highlighted the efficacy of intranasal corticosteroids in patients aged 12 years and older. The study was the first to confirm these effects through a comprehensive review and analysis.

However, investigators mentioned limitations including the variability in the duration of the studies — ranging from two to 26 weeks — which could have influenced the comparability of the results. Additionally, geographic bias may have been introduced as the majority of RCTs were conducted in the United States or Canada. Investigators noted this as relevant because allergens can vary significantly across different regions of the world.

“These findings support the use of intranasal corticosteroids as a first-line treatment for AR, not only for managing daytime symptoms but also for enhancing sleep quality,” investigators concluded. “Future research should focus on sleep quality changes as a primary outcome and incorporate both subjective and objective measures to better understand the relationship between sleep and AR symptoms.”