Dust Mite Allergy and the Risk of Sleep-Disordered Breathing
New York authors in their recently published retrospective analysis tested the hypothesis that individuals with allergic rhinitis caused by dust mite allergy have an increased risk of breathing disorders during the REM phase of sleep, based on objective polysomnography evaluation.
Analysis Methodology and Evaluated Population
Data from 100 individuals (54 men and 46 women) were analyzed, of which 46 had a positive dust mite allergy test. Individuals without dust mite allergy were significantly older on average than those with allergy (55 vs. 46 years). The average body mass index (BMI) was 30.5 kg/m2 for individuals without dust mite allergy and 28.4 kg/m2 for those with the allergy. Arterial hypertension was present in 48.5% of patients without dust mite allergy and 40.4% with the allergy. A total of 20 patients showed sensitivity to other allergens.
All patients underwent polysomnography with calculations of the respiratory disturbance index (RDI) and the apnea/hypopnea index (AHI), both during REM sleep and throughout the night. RDI includes the occurrence of apnea (defined as a cessation of breathing or a >90% decrease in peak inspiratory airflow lasting at least 10 seconds), hypopnea (defined as a >30% decrease in peak inspiratory airflow lasting at least 10 seconds, leading to a >3% reduction in oxygen saturation), and respiratory effort related arousals (RERA). RDI during REM sleep was expressed as the number of events per hour. A value of 0–4.9 is considered normal, 5–14.9 as a mild disturbance, 15–29.9 as a moderate disturbance, and ≥30 as a severe disturbance. AHI includes only the occurrences of apnea and hypopnea. Logistic regression analysis adjusted for potential confounders was used to assess the relationship between the presence of allergy and the parameters measured during polysomnography.
Results
The likelihood of moderate/severe respiratory disorder during REM sleep, defined as RDI ≥15 events/hour (REM-RDI), was significantly higher in individuals with dust mite allergy (odds ratio [OR] 4.29; 95% confidence interval [CI] 1.26–14.62). A similar association was found for the occurrence of apnea/hypopnea during REM sleep (REM-AHI) (OR 3.98; 95% CI 1.08–14.68).
BMI was also an independent predictor of moderate/severe REM-RDI and REM-AHI. There was no significant difference in REM-RDI among patients sensitive to other allergens compared to those without allergies. A higher risk of REM-RDI ≥30/hour was observed even when comparing individuals with dust mite allergy to those without any allergies.
Conclusion
This study demonstrated a significant association between dust mite allergy and sleep-disordered breathing in the form of increased occurrences of apnea, hypopnea, and respiratory effort related arousals during the REM phase of sleep. This highlights not only the inadequately treated sleep disorders among patients with allergic rhinitis but also the necessity to consider dust mite allergy testing in patients with sleep disorders. Additionally, it is recommended to use anti-mite treatments for home mattresses.
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Source: Berson S. R., Klimczak J. A., Prezio E. A., Abraham M. T. House dust mite related allergic rhinitis and REM sleep disturbances. Am J Otolaryngol 2020; 41 (6): 102709, doi: 10.1016/j.amjoto.2020.102709.
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