House Dust Mite Related Allergic Rhinitis and REM Sleep Disturbances

Abstract

Purpose: Sleep disturbances are common in patients with allergic rhinitis (AR). Perennial allergens like house dust mites (HDM) are difficult to avoid and have nocturnal impacts on the respiratory system and Quality of Life (QOL). The Rapid Eye Movement (REM) sleep stage is associated with memory, cognition, dreams, and overall restfulness, which can be impaired in AR patients with Sleep Disordered Breathing (SDB) even when normal all-night apnea-hypopnea (AHI) or respiratory disturbance (RDI) indices are noted on polysomnography (PSG). We hypothesized that AR HDM allergen positive patients would show REM-specific SDB reflected in their objectively elevated REM-RDI values.

Materials and methods: This retrospective analysis of 100 patients included 47 with HDM positive allergy testing. All patients underwent PSG testing calculating the RDI during REM. Multivariate logistic regression models evaluated relationships between allergic statuses and sleep parameters while controlling for potential confounders.

Results: Compared with allergy negative patients, HDM allergen positive patients were significantly more likely (OR 4.29, 95%CI 1.26-14.62) to have a REM-RDI in the moderate/severe range (≥15 events/h).

Conclusions: Our study highlighted the significance of respiratory allergies to HDM in patients with SDB. We revealed a significant relationship between HDM allergen positivity and SDB characterized by elevated REM-RDI regardless of all-night AHI, RDI, or REM-AHI values. Clinical implications of knowing about disturbed REM and/or HDM allergenicity include better preparation, treatment, outcomes, and QOL for allergic, SDB, and upper airway surgery patients.

Keywords: Allergic Rhinitis (AR); Apnea Hypopnea Index (AHI); House Dust Mites (HDM); Intradermal Testing (IDT); Non-Rapid Eye Movement (NREM); Obstructive Sleep Apnea (OSA); Perennial allergens; REM-RDI; Rapid-Eye Movement (REM); Respiratory Distress Index (RDI); Respiratory Event Related Arousal (RERA); Skin Prick Test (SPT); Sleep Disordered Breathing (SDB); Sublingual Immunotherapy (SLIT).