Association of allergic rhinitis with polysomnographic arousal indices in children with sleep-disordered breathing

Abstract Background Children with allergic rhinitis (AR) frequently experience sleep disruption and have a higher prevalence of sleep-disordered breathing (SDB). However, the specific impact of AR on sleep architecture across different SDB subtypes, such as obstructive sleep apnea (OSA) and snoring, remains under-explored. This study examined the associations between AR, arousal indices, and sleep architecture in children with OSA and snoring. Methods This retrospective study analyzed polysomnography (PSG) data from children (< 12 years) evaluated for SDB at a tertiary hospital in Taiwan (2009–2020). Participants were classified into four groups based on PSG findings and clinical diagnosis. Multivariable regression was used to analyze the associations between AR and OSA-related parameters. Results Among 643 children (mean age < 12 years), those with OSA and comorbid AR exhibited significantly more respiratory events and a higher respiratory arousal index (RAI) than those without AR (both P < 0.001). Multivariable negative binomial regression revealed that AR was independently associated with a lower periodic limb movement arousal rate (aIRR = 0.393, 95% CI: 0.183–0.848, P = 0.017), even after adjusting for comorbid asthma and OSA status. Additionally, older age (aIRR = 0.914, P = 0.011), male sex (aIRR = 1.643, P = 0.006), higher BMI (aIRR = 1.048, P = 0.018), presence of OSA (aIRR = 12.382, P < 0.0001), and enuresis (aIRR = 2.065, P = 0.029) were significantly associated with respiratory arousal rates. Conclusions This study provides the first evidence of a significant link between AR and impaired arousal regulation in pediatric SDB. These findings underscore the necessity of screening for sleep disturbances in children with AR and suggest that managing comorbid AR is a critical component of pediatric sleep disorder therapy.