The Association Between Obstructive Sleep Apnea and Allergic Rhinitis: Current Literature Review

Sleep-disordered breathing (SDB) is now a significant health problem in today's culture. It ranges from a spectrum of abnormal conditions during sleep from the primary snorer to mild, moderate, or severe obstructive sleep apnea (OSA). SDB also comprises other conditions, such as sleep-related hypoventilation, sleep-related hypoxemia, and central sleep apnea syndromes. One of the components of the pathophysiology of OSA that remain unclear is the association of allergic rhinitis (AR) in the evolution of OSA. Several studies relate the co-existence of OSA and AR in the common clinical practice, but its correlation was not clear. This review article aimed to review the pathophysiological relationship between OSA and AR in terms of the role of chemical mediators and the effect of AR treatment in support of OSA. The symptoms of AR further accelerate the clinical progression to OSA development. Inflammatory mediators such as histamine, cysteinyl leukotrienes, and interleukins are found at a high level in AR, which can aggravate AR symptoms such as nasal obstruction, rhinorrhea, and itchiness, which can then lead to sleep disruption in OSA patients. In addition, OSA patients also have increased chemical mediators such as tumor necrosis factor, interleukin 6, and 1, which would activate the T helper 2 phenotypes that can aggravate AR symptoms. This vicious cycle can potentiate each other and worsen the condition. Few studies have shown that treatment of AR can improve OSA, especially the use of intranasal steroid and leukotriene receptor antagonists. A detailed evaluation of rhinitis symptoms should be made for OSA patients so that they can benefit not only from the improvement of AR but also the good sleep quality.