Sleep disturbances in children with allergic rhinitis: Associations with rhinitis control and treatment response

Allergic rhinitis (AR), a common pediatric condition, is an established contributor to impaired sleep and sleep-disordered breathing. However, data on the relative impact of disease severity versus control on sleep remain limited. We aimed to investigate the associations between AR severity, disease control, and treatment response and sleep quality in Turkish children.

In this prospective study, 65 children aged 4-15 years with AR and 67 age-matched healthy controls were evaluated. Sleep quality, AR control, and AR severity were assessed using the Children's Sleep Habits Questionnaire (CSHQ), the Rhinoconjunctivitis Control Assessment Test (RCAT), and its Impact on Asthma (ARIA) guidelines, respectively. CSHQ scores were compared according to AR severity and control status and evaluated before and after three months of treatment.

Mean CSHQ scores were higher in the AR group than in controls (53.7 ± 8.7 vs. 47.5 ± 8.0, p < 0.001). AR was associated with disturbances in several CSHQ subdomains, including difficulty waking, fragmented sleep, sleep-disordered breathing, and parasomnias. CSHQ scores did not differ across AR severity categories (p = 0.216) but showed an inverse correlation with RCAT scores (r = -0.40, p = 0.001). Among 46 treated patients, sleep quality improved after therapy, particularly in the sleep fragmentation and sleep anxiety domains, with no significant difference between montelukast monotherapy and combined montelukast plus antihistamine therapy.

In children with AR, sleep impairment is more closely related to rhinitis control than to symptom-based severity. Optimizing disease control, rather than focusing solely on severity, appears crucial for improving sleep and related functional outcomes.