Sleep-Disordered Breathing and Upper Airway Allergy: A Survey of Allergists' Practices

Rationale: Patients with rhinitis frequently report symptoms of sleep-disordered breathing (SDB), including obstructive sleep apnea (OSA).   However, published OSA guidelines relegate the role of the allergist to that of adjunctive support, recommending rhinitis treatment solely for intolerance to CPAP.  We surveyed the Academy membership regarding members’ clinical practice with SDB in adults and children with rhinitis and/or adenotonsillar hypertrophy.

Methods: A 16-item questionnaire was distributed electronically to 4,881 AAAAI members.  The questionnaire asked respondents to indicate their scope-of-practice (adult, pediatric, or both), and depending upon the response, presented them with a series of patient-age-appropriate questions pertaining to their clinical experience and diagnostic and therapeutic practice.

Results: Questionnaire responses were received from 339 members (7%), including 293 from the US, 14 from Canada, and 32 from other countries.   Of respondents, 82% treated both adults and children, with 9% each treating children or adults only.  Further, 72% routinely asked about sleep quality, and 60% believed that a "substantial minority" of their patients (10-30%) manifest symptoms of SDB.  Only 14% reported using paper-and-pencil screening tests in suspected SDB.  Interestingly, 70% of respondents "often" deferred polysomnography (PSG) until after treatment of the primary disease, and if SDB persisted, PSG was ordered.  Respondents evaluating children with suspected adenotonsillar hypertrophy frequently managed cases in collaboration with an otolaryngologist.

Conclusions: Based on our limited sample, AAAAI members perceive SDB as a frequent occurrence in allergy practice, and find that treatment of rhinitis or adenotonsillar hypertrophy may help ameliorate the associated SDB symptoms in at least a subset of patients.