Clinical efficacy of sublingual immunotherapy for house dust mite-allergic rhinitis with sleep disturbances
Allergic rhinitis (AR) causes sleep disturbances. However, studies reporting the impact of sublingual immunotherapy (SLIT) for AR-related sleep disturbances are limited. The purpose of this study was, for the first time, to evaluate in detail the impact of a 6-month SLIT treatment on the quality of...
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| Published in | Journal of Immunology, Allergy and Infection in Otorhinolaryngology Vol. 2; no. 1; pp. 19 - 24 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
Japan Society of Immunology, Allergology and Infection in Otorhinolaryngology
2022
日本耳鼻咽喉科免疫アレルギー感染症学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 2435-7952 |
| DOI | 10.24805/jiaio.2.1_19 |
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| Abstract | Allergic rhinitis (AR) causes sleep disturbances. However, studies reporting the impact of sublingual immunotherapy (SLIT) for AR-related sleep disturbances are limited. The purpose of this study was, for the first time, to evaluate in detail the impact of a 6-month SLIT treatment on the quality of sleep in house dust mite (HDM)-AR patients.The total nasal symptom score (TNSS) and sleep disturbances in AR patients sensitive to HDM (n=23) were evaluated and compared using questionnaires accomplished by those who participated in the study. The questionnaire-based evaluation was repeated after 6 months of SLIT treatment to investigate the changes in TNSS and sleep disturbances due to the therapeutic intervention. We classified the subjects into two groups based on the baseline Pittsburgh sleep quality index (PSQI) score: one with no sleep disturbances before the start of treatment (normal-sleeping subjects, n=10, PSQI<6) and the other with sleep disturbances (poor-sleeping subjects, n=13, PSQI≥6).PSQI was correlated positively with nasal obstruction score in the pretreatment phase (r=0.66, p<0.05). TNSS and PSQI scores improved significantly after 6 months of SLIT. After stratification, the nasal obstruction scores and PSQI scores did not vary significantly before and after treatment in the normal-sleeping subjects’ group, but the other group showed significant improvements after treatment.SLIT may improve both nasal symptoms and the quality of sleep in HDM-AR patients suffering from sleep disturbances. Therefore, encouraging patients with AR to continue SLIT for as long as possible may help in improving their sleep quality. |
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| AbstractList | Allergic rhinitis (AR) causes sleep disturbances. However, studies reporting the impact of sublingual immunotherapy (SLIT) for AR-related sleep disturbances are limited. The purpose of this study was, for the first time, to evaluate in detail the impact of a 6-month SLIT treatment on the quality of sleep in house dust mite (HDM)-AR patients.The total nasal symptom score (TNSS) and sleep disturbances in AR patients sensitive to HDM (n=23) were evaluated and compared using questionnaires accomplished by those who participated in the study. The questionnaire-based evaluation was repeated after 6 months of SLIT treatment to investigate the changes in TNSS and sleep disturbances due to the therapeutic intervention. We classified the subjects into two groups based on the baseline Pittsburgh sleep quality index (PSQI) score: one with no sleep disturbances before the start of treatment (normal-sleeping subjects, n=10, PSQI<6) and the other with sleep disturbances (poor-sleeping subjects, n=13, PSQI≥6).PSQI was correlated positively with nasal obstruction score in the pretreatment phase (r=0.66, p<0.05). TNSS and PSQI scores improved significantly after 6 months of SLIT. After stratification, the nasal obstruction scores and PSQI scores did not vary significantly before and after treatment in the normal-sleeping subjects’ group, but the other group showed significant improvements after treatment.SLIT may improve both nasal symptoms and the quality of sleep in HDM-AR patients suffering from sleep disturbances. Therefore, encouraging patients with AR to continue SLIT for as long as possible may help in improving their sleep quality.
【目的】アレルギー性鼻炎は鼻腔抵抗の上昇を来すだけでなく，血清中のヒスタミン，IL-4，CysLTsの高値がREM潜時の延長を引き起こすことから，睡眠障害に関与することが報告されている。睡眠障害を訴えるアレルギー性鼻炎患者に対し，舌下免疫療法による介入が睡眠に与える影響について検討した。【方法】通年性アレルギー性鼻炎患者23名に対し，舌下免疫療法開始前にピッツバーグ睡眠質問診票（PSQI）を用いて睡眠障害の有無を層別化した。舌下免疫療法6ヵ月後に鼻症状スコアと同時に再びPSQIを評価し，それぞれの群で治療介入前後のスコアの比較を行った。【結果】舌下免疫療法開始前PSQI6未満の群ではくしゃみ，鼻汁，合計鼻症状スコアにおいて治療前後で有意に改善を認めた。一方で舌下免疫療法開始前PSQI6以上の群ではこれら3項目に加えて鼻閉とPSQIスコアにおいて治療前後で有意に改善を認めた。PSQIのコンポーネントで解析を行うと，睡眠時間や入眠に対する服薬行動などに統計学的差異はない上で「睡眠の質」，「入眠時間」の項目で有意に改善を認めた。【結論】睡眠障害の自覚のある通年性アレルギー性鼻炎患者に対しダニ舌下免疫療法による介入を行うことによって，睡眠障害を改善できる可能性が示唆された。 Allergic rhinitis (AR) causes sleep disturbances. However, studies reporting the impact of sublingual immunotherapy (SLIT) for AR-related sleep disturbances are limited. The purpose of this study was, for the first time, to evaluate in detail the impact of a 6-month SLIT treatment on the quality of sleep in house dust mite (HDM)-AR patients.The total nasal symptom score (TNSS) and sleep disturbances in AR patients sensitive to HDM (n=23) were evaluated and compared using questionnaires accomplished by those who participated in the study. The questionnaire-based evaluation was repeated after 6 months of SLIT treatment to investigate the changes in TNSS and sleep disturbances due to the therapeutic intervention. We classified the subjects into two groups based on the baseline Pittsburgh sleep quality index (PSQI) score: one with no sleep disturbances before the start of treatment (normal-sleeping subjects, n=10, PSQI<6) and the other with sleep disturbances (poor-sleeping subjects, n=13, PSQI≥6).PSQI was correlated positively with nasal obstruction score in the pretreatment phase (r=0.66, p<0.05). TNSS and PSQI scores improved significantly after 6 months of SLIT. After stratification, the nasal obstruction scores and PSQI scores did not vary significantly before and after treatment in the normal-sleeping subjects’ group, but the other group showed significant improvements after treatment.SLIT may improve both nasal symptoms and the quality of sleep in HDM-AR patients suffering from sleep disturbances. Therefore, encouraging patients with AR to continue SLIT for as long as possible may help in improving their sleep quality. |
| Author | Ikeda, Katsuhisa Inoshita, Ayako Ide, Takuma Nakamura, Masahiro Matsumoto, Fumihiko |
| Author_FL | 井下 綾子 池田 勝久 Nakamura Masahiro 井出 拓磨 松本 文彦 |
| Author_FL_xml | – sequence: 1 fullname: Nakamura Masahiro – sequence: 2 fullname: 井出 拓磨 – sequence: 3 fullname: 井下 綾子 – sequence: 4 fullname: 池田 勝久 – sequence: 5 fullname: 松本 文彦 |
| Author_xml | – sequence: 1 fullname: Ikeda, Katsuhisa organization: Department of Otorhinolaryngology, Juntendo University, Faculty of Medicine – sequence: 1 fullname: Ide, Takuma organization: Atopy (Allergy) Research Center, Juntendo University School of Medicine – sequence: 1 fullname: Inoshita, Ayako organization: Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital – sequence: 1 fullname: Nakamura, Masahiro organization: Department of Otorhinolaryngology, Juntendo University, Faculty of Medicine – sequence: 1 fullname: Matsumoto, Fumihiko organization: Department of Otorhinolaryngology, Juntendo University, Faculty of Medicine |
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| References | 4)Santos CB, Hanks C, McCann J, et al.: The role of montelukast on perennial allergic rhinitis and associated sleep disturbances and daytime somnolence. Allergy Asthma Proc 2008; 29: 140–145. 10)Muliol J, Maurer M, Bousquet J: Sleep and allergic rhinitis. J Investig Allergol Clin Immunol 2008; 18: 415–419. 6)Kiely JL, Nolan P, McNicholas WT: Intranasal corticosteroid therapy for obstructive sleep apnoea in patients with co-existing rhinitis. Thorax 2004; 59: 50–55. 5)Hara H, Sugahara K, Hashimoto M, et al.: Effectiveness of the leukotriene receptor antagonist pranlukast hydrate for the treatment of sleep disorder in patients with perennial allergic rhinitis. Acta Otolaryngol 2014; 134: 307–313. 12)Leger D, Morin CM, Uchiyama M, et al.: Chronic insomnia, quality-of-life, and utility scores: Comparison with good sleepers in a cross-sectional international survey. Sleep Med 2012; 13: 43–51. 15)大木幹文，鈴木立俊：睡眠時無呼吸症患者の鼻アレルギーの関係と局所ステロイド点鼻薬の有用性．耳鼻免疫アレルギー 2018; 36: 173–174. 16)Fujii T, Kitamura Y, Kamimura S, et al.: Effects of sublingual immunotherapy on nasal symptoms and sleep disturbance in patients with Japanese cedar pollinosis. Auris Nasus Larynx 2021; 48: 653–658. 3)Chirakalwasan N, Ruxrungtham K: The linkage of allergic rhinitis and obstructive sleep apnea. Asian Pac J Allergy Immunol 2014; 32: 276–286. 7)Acar M, Cingi C, Sakallioglu O, et al.: The effects of mometasone furoate and desloratadine in obstructive sleep apnea syndrome patients with allergic rhinitis. Am J Rhinol Allergy 2013; 27: e113–e116. 8)鼻アレルギー診療ガイドライン作成委員会：鼻アレルギー診療ガイドライン―通年性鼻炎と花粉症―2020年版（改訂第9版）．ライフサイエンス；2021. 11)Thompson A, Sardana N, Craig TJ: Sleep impairment and daytime sleepiness in patients with allergic rhinitis: The role of congestion and inflammation. Ann Allergy Asthma Immunol 2013; 111: 446–451. 9)Bousquet J, Khaltaev N, Cruz AA, et al.: Allergic rhinitis and its impact on asthma (ARIA) 2008 update (in collaboration with the world health organization, GA(2)LEN and AllerGen). Allergy 2008; 63: 8–160. 13)Chiba S, Chan-Soon P: Establishing a patent nasal passage in obstructive sleep apnea. Sleep Med Clin 2019; 14: 41–50. 1)Ferguson BJ: Influences of allergic rhinitis on sleep. Otolaryngol Head Neck Surg 2004; 130: 617–629. 14)Leger D, Bonnefoy B, Pigearias B, et al.: Poor sleep is highly associated with house dust mite allergic rhinitis in adults and children. Allergy Asthma Clin Immunol 2017; 13: 36. 17)Buysse DJ, Reynolds CF 3rd, Monk TH, et al.: The pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatr Res 1989; 28: 193–213. 2)Craig TJ, McCann JL, Gurevich F, et al.: The correlation between allergic rhinitis and sleep disturbance. J Allergy Clin Immunol 2004; 114: S139–S145. |
| References_xml | – reference: 8)鼻アレルギー診療ガイドライン作成委員会：鼻アレルギー診療ガイドライン―通年性鼻炎と花粉症―2020年版（改訂第9版）．ライフサイエンス；2021. – reference: 11)Thompson A, Sardana N, Craig TJ: Sleep impairment and daytime sleepiness in patients with allergic rhinitis: The role of congestion and inflammation. Ann Allergy Asthma Immunol 2013; 111: 446–451. – reference: 1)Ferguson BJ: Influences of allergic rhinitis on sleep. Otolaryngol Head Neck Surg 2004; 130: 617–629. – reference: 2)Craig TJ, McCann JL, Gurevich F, et al.: The correlation between allergic rhinitis and sleep disturbance. J Allergy Clin Immunol 2004; 114: S139–S145. – reference: 6)Kiely JL, Nolan P, McNicholas WT: Intranasal corticosteroid therapy for obstructive sleep apnoea in patients with co-existing rhinitis. Thorax 2004; 59: 50–55. – reference: 5)Hara H, Sugahara K, Hashimoto M, et al.: Effectiveness of the leukotriene receptor antagonist pranlukast hydrate for the treatment of sleep disorder in patients with perennial allergic rhinitis. Acta Otolaryngol 2014; 134: 307–313. – reference: 3)Chirakalwasan N, Ruxrungtham K: The linkage of allergic rhinitis and obstructive sleep apnea. Asian Pac J Allergy Immunol 2014; 32: 276–286. – reference: 14)Leger D, Bonnefoy B, Pigearias B, et al.: Poor sleep is highly associated with house dust mite allergic rhinitis in adults and children. Allergy Asthma Clin Immunol 2017; 13: 36. – reference: 9)Bousquet J, Khaltaev N, Cruz AA, et al.: Allergic rhinitis and its impact on asthma (ARIA) 2008 update (in collaboration with the world health organization, GA(2)LEN and AllerGen). Allergy 2008; 63: 8–160. – reference: 13)Chiba S, Chan-Soon P: Establishing a patent nasal passage in obstructive sleep apnea. Sleep Med Clin 2019; 14: 41–50. – reference: 4)Santos CB, Hanks C, McCann J, et al.: The role of montelukast on perennial allergic rhinitis and associated sleep disturbances and daytime somnolence. Allergy Asthma Proc 2008; 29: 140–145. – reference: 7)Acar M, Cingi C, Sakallioglu O, et al.: The effects of mometasone furoate and desloratadine in obstructive sleep apnea syndrome patients with allergic rhinitis. Am J Rhinol Allergy 2013; 27: e113–e116. – reference: 17)Buysse DJ, Reynolds CF 3rd, Monk TH, et al.: The pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatr Res 1989; 28: 193–213. – reference: 10)Muliol J, Maurer M, Bousquet J: Sleep and allergic rhinitis. J Investig Allergol Clin Immunol 2008; 18: 415–419. – reference: 12)Leger D, Morin CM, Uchiyama M, et al.: Chronic insomnia, quality-of-life, and utility scores: Comparison with good sleepers in a cross-sectional international survey. Sleep Med 2012; 13: 43–51. – reference: 15)大木幹文，鈴木立俊：睡眠時無呼吸症患者の鼻アレルギーの関係と局所ステロイド点鼻薬の有用性．耳鼻免疫アレルギー 2018; 36: 173–174. – reference: 16)Fujii T, Kitamura Y, Kamimura S, et al.: Effects of sublingual immunotherapy on nasal symptoms and sleep disturbance in patients with Japanese cedar pollinosis. Auris Nasus Larynx 2021; 48: 653–658. |
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| SubjectTerms | allergic rhinitis Pittsburgh sleep quality index sleep disturbances sublingual immunotherapy アレルギー性鼻炎 ピッツバーグ睡眠質問診票 睡眠障害 舌下免疫療法 |
| Title | Clinical efficacy of sublingual immunotherapy for house dust mite-allergic rhinitis with sleep disturbances |
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