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Meta-Analysis
. 2020 Feb 13;15(2):e0228533.
doi: 10.1371/journal.pone.0228533. eCollection 2020.

The association between allergic rhinitis and sleep: A systematic review and meta-analysis of observational studies

Affiliations
Meta-Analysis

The association between allergic rhinitis and sleep: A systematic review and meta-analysis of observational studies

Jiaomei Liu et al. PLoS One. .

Abstract

This systematic review and meta-analysis examines the associations of allergic rhinitis with sleep duration and sleep impairment. Observational studies published before August 2019 were obtained through English language literature searches in the PubMed, Embase, and CINAHL databases. Mean differences and odds ratios with 95% confidence intervals were extracted and used for meta-analysis. Heterogeneity was confirmed by the I2-heterogeneity test. Subgroup analysis was conducted to evaluate the influence of study design. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to determine the level of evidence. In total, 2544 records were identified through database searches; 914 duplicate records were excluded, 1452 records were removed after screening of titles and abstracts, 151 records were excluded after full-text screening, and 27 articles were included in the final meta-analyses. A total of 240,706,026 patients (19,444,043 with allergic rhinitis) were considered. No significant difference in sleep duration between the allergic rhinitis and the control groups was found. Patients with allergic rhinitis presented with significantly higher sleep quality scores, sleep disturbances scores, and sleep latency scores; more frequent use of sleep medications; and lower sleep efficiency as measured by the Pittsburgh Sleep Quality Index and polysomnography. Meta-analyses for adjusted odds ratios showed that allergic rhinitis was also associated with higher risks of nocturnal dysfunctions, including insomnia, nocturnal enuresis, restless sleep, sleep-disordered breathing, obstructive sleep apnea, and snoring. Meta-analysis for adjusted odds ratio also showed that allergic rhinitis was associated with daytime dysfunction, including difficulty waking up, daytime sleepiness, morning headache, and the use of sleep medications. The overall quality of evidence ranged from low to very low, indicating that caution is required when interpreting these results. This study demonstrates that there is a significant association of AR with sleep characteristics.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram of the literature search and selection processes.
Fig 2
Fig 2. Comparative analysis of sleep duration.
AR: allergic rhinitis; CI: confidence interval; MD: mean difference; OSA: obstructive sleep apnea; PSG: polysomnography.
Fig 3
Fig 3. Comparative analysis of PSQI scale, ESS scale, and PSG outcomes.
AHI: apnea-hypopnea index; ESS: Epworth Sleepiness Scale; PSQI: Pittsburgh Sleep Quality Index; REM: rapid eye movement.
Fig 4
Fig 4. Forest plot for adjusted associations between AR and sleep outcomes.
AR: allergic rhinitis; CI: confidence interval; OR: odds ratio; OSA: obstructive sleep apnea; SDB: sleep-disordered breathing.

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Grants and funding

JM L received award from South Campus of Guang’anmen Hospital, China Academy of Chinese Medical Sciences (http://www.gamhnq.cn/). The grant number is 121102244009641085. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.