Allergic rhinitis and inner-city children - Is there a relationship to sleep-disordered breathing?

Background: Allergic rhinitis (AR) causes increased upper airway resistance and may lead to undiagnosed sleep-disordered breathing (SDB). This problem may be further complicated in the pediatric inner-city population where indoor allergens such as rat, cockroach, and mouse may contribute to morbidity. Objective: To determine the pattern of aeroallergen sensitization in inner-city pediatric patients with SDB and to determine if intranasal corticosteroid treatment improves SDB, using a validated Pediatric Sleep Questionnaire (PSQ). Methods: Patients (ages 2-18) were evaluated for AR and completed the PSQ prior to treatment. Skin prick testing (SPT) to aeroallergens, including inner-city culprits (rat, cockroach, and mouse), was performed. Patients with a history of AR, a positive SPT evaluation, and at least one positive response on the PSQ were treated with intranasal mometasone furoate monohydrate, environmental control, (±) antihistamines. After 6 weeks of treatment, PSQ responses were reassessed. Results: Of the 23 patients recruited in this study, 100% had SDB as per screening PSQ responses; 100% had 1 positive SPT, 78% of which were SPT-positive to cockroach, mouse, or rat. Prior to treatment, patients' average PSQ score = 6.00 questions; following treatment, an average PSQ score = 2.35, indicating clinical improvement (P < 0.0001 paired t test). Conclusion: Children suffering from AR have increased nasal obstruction leading to sleep-disordered events. This study demonstrated that adequate treatment, that is, intranasal steroids, may significantly improve SDB. In inner-city children, elimination of indoor allergens such as cockroach, mouse, or rat may further improve SDB. Larger prospective studies are needed to further validate these preliminary results.