Evaluating the relationship between allergic rhinitis and sleep disordered breathing: a retrospective case series

Background: Understanding the relationship between allergic rhinitis and sleep disordered breathing (SDB) can help manage both conditions to a higher standard in clinical practice, potentially reducing inadequate treatment of patient symptoms and rationalising the role of surgery. While this has been investigated previously, research has been limited by its qualitative nature and small sample sizes. Methods: A retrospective case control study was conducted on paediatric patients who had undergone tonsil, adenoid or turbinate surgery at a private ear, nose and throat clinic in Townsville, Australia from 1 January 2017 to 31 December 2022. Patients were included if they had allergy testing, and had symptoms and/or examination findings of allergic rhinitis. The primary outcome evaluated the relationship between immunoglobulin E (IgE) status and signs/symptoms of SDB. The secondary outcome was determining the sensitivity and specificity of total IgE (tIgE) and specific IgE (sIgE) for allergic rhinitis signs and symptoms. Pearsons chi-square test was used for categorical variables and the independent t-test for continuous variables. Results: A total of 410 patients met the inclusion criteria with allergy test positive patients more likely to be male (73% vs. 60%), older (≥5 years old) and have a history of atopy (16.0% vs. 8.6%). The only SDB symptom/sign that was significantly associated with a positive tIgE was diaphoresis (P=0.009, n=46), and that to only for patients less than or equal to 4 years old. There was no similar correlation with sIgE, and there were no other correlations for snoring, apnoea, daytime somnolence, poor behaviour, restless sleep, enuresis, tonsil grade or adenoid grade. The sensitivity and specificity of IgE testing for allergic rhinitis signs and symptoms was found to be relatively poor, ranging from 32.6% to 66.3% and 21.4% to 61.3% respectively, depending on the age group (<5 and ≥5 years old) and whether it is sIgE or tIgE. Conclusions: There was no strong correlation between IgE-positive allergic rhinitis and SDB in this large retrospective case series, likely explained by the poor sensitivity and specificity of IgE testing.