The interplay of chronic rhinitis and sleep-disordered breathing

PURPOSE OF REVIEW: This review examines how chronic rhinitis contributes to sleep-disordered breathing (SDB), shifting the focus from a localized nasal issue to a systemic sleep and respiratory disorder. It highlights inflammatory mechanisms that affect sleep differently from mechanical nasal obstruction, which worsens airway collapsibility. RECENT FINDINGS: Evidence indicates that chronic rhinitis, regardless of allergy status, is associated with sleep fragmentation and lighter non-REM sleep, with some groups showing reduced REM sleep. Sleep improves, including partial REM restoration, after procedures such as functional endoscopic sinonasal surgery (including turbinoplasty and posterior nasal neurectomy) that reduce nasal resistance. NOSE scale scores, which reflect nasal obstruction severity, correlate with markers of respiratory instability, such as oxygen desaturation and epiglottic collapse, during sleep endoscopy. Excessive daytime sleepiness (ESS) reflects sleep fragmentation rather than specific respiratory events. Rhinitis-related sleep disruption involves oxidative stress and autonomic pathways beyond IgE-mediated inflammation, leading to hypoxia and systemic effects. SUMMARY: Nasal airflow and inflammation are key determinants of sleep quality and respiratory stability. Using symptom-based tools with physiological assessments could better identify early and atypical SDB types. Treatments that open nasal passages and reduce inflammation may improve sleep and reduce intermittent hypoxia.