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Narrative Review Links Allergies and Impaired Sleep in Children
A narrative review reports the connection between allergies and sleep and available treatment options for both conditions.
A narrative review highlights a strong link between allergies and impaired sleep in children, with nasal congestion, wheezing, and itching disrupting sleep patterns.1
The review examined many studies conducted in Saudi Arabia which has a high prevalence of allergic diseases in children, such as allergic rhinitis, asthma, and atopic dermatitis.2 Studies also demonstrated increased sleep issues among children, such as sleep apnea, insomnia, and restless legs syndrome.3
Allergic conditions can contribute to sleep fragmentation, obstructive sleep apnea (OSA), and excessive daytime sleepiness, negatively affecting cognitive function, behavior, and overall well-being.1
Allergic rhinitis may worsen or lead to the development of OSA, though the mechanism remains unclear.
“It is believed that nasal congestion and inflammation caused by allergic rhinitis can lead to upper airway obstruction during sleep,” wrote author Maryam Saud Aljaid, from the department of pediatrics at Taif University in Saudi Arabia. “Increased nasal resistance can affect the collapsibility of the upper airway, and nasal congestion may lead to mouth breathing, further increasing the risk of upper airway collapse and OSA.”
Asthma is also tied to sleep disorders in children, causing difficulty falling asleep, frequent awakenings throughout the night, and daytime fatigue. Aljaid wrote that patients may have impacted sleep due to the inflammatory nature of asthma.
With asthma, the body releases inflammatory mediators that may disrupt sleep regulation and heighten arousal responses. Asthma symptoms often worsen at night, with both their severity and frequent rescue inhaler use disrupting sleep.
Furthermore, children with atopic dermatitis often experience difficulties falling asleep and nighttime awakenings. The more severe the atopic dermatitis, the poorer the sleep quality. Atopic dermatitis and sleep disturbances exacerbate each other; while inadequate sleep can increase stress, weaken immune function, and heighten skin inflammation, atopic dermatitis can directly interfere with sleep quality.
For children with atopic dermatitis and sleep issues, both conditions need to be treated. For instance, atopic dermatitis can be addressed with topical creams and good skincare practices to relieve skin inflammation and itching. Moreover, sleep issues could be improved by establishing a bedtime routine focusing on relaxation, reducing itching, and creating a comfortable sleep environment.
Many sleep treatments exist. For instance, patients can undergo cognitive-behavioral therapy for insomnia and continuous positive airway pressure therapy or adenotonsillectomy in severe cases of sleep apnea.
Some sleep disorders can simply be managed by making lifestyle changes. For instance, patients with restless legs syndrome can adapt their lifestyle by avoiding caffeine, maintaining a regular sleep schedule, and taking medications of dopamine agonists or iron supplements. It is recommended for patients with parasomnias to create a safe sleep environment and manage stress or anxiety with medication or specialized interventions.
Pharmacological interventions can be important in managing allergy symptoms. Antihistamines can improve symptoms of sneezing, itching, and nasal congestion; inhaled corticosteroids and bronchodilators reduce inflammation and improve breathing associated with asthma, topical steroids, and emollients help control skin inflammation and maintain hydration for atopic dermatitis.
Managing allergy symptoms with allergen avoidance strategies or immunotherapy can also improve sleep outcomes. Patients can undergo subcutaneous or sublingual immunotherapy, one with allergen injections and allergen extracts respectively.
Lately, emerging techniques have entered the field: epicutaneous immunotherapy (EPIT) and intralymphatic immunotherapy. Biologics and immunomodulatory agents are being evaluated to improve the immune response during immunotherapy.
“Further research is needed to better understand the mechanisms behind this relationship and to develop more effective management strategies for children suffering from both allergic diseases and sleep disorders,” investigators concluded.
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