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Treatment of Sleep Associate disturbance in Allergy Diseases

Treatment of Sleep Associate disturbance in Allergy Diseases. Timothy J. Craig Professor of Medicine and Pediatrics Distinguished Educator Penn State University. Presentation Overview. Allergic Rhinitis and Sleep Disturbance Mechanisms of Sleep Disturbance in Allergic Rhinitis

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Treatment of Sleep Associate disturbance in Allergy Diseases

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  1. Treatment of Sleep Associate disturbance in Allergy Diseases Timothy J. Craig Professor of Medicine and Pediatrics Distinguished Educator Penn State University

  2. Presentation Overview • Allergic Rhinitis and Sleep Disturbance • Mechanisms of Sleep Disturbance in Allergic Rhinitis • Impact of AR-associated Sleep Disturbances • Effects of Allergic Rhinitis Therapies on Sleep and Quality of Life

  3. conflicts of interest with this presentation • Merck- speaker, researcher, consultant • Astra-Zeneca- speaker • Teva- speaker • GSK- researcher

  4. Allergic Rhinitis Adversely Impacts Sleep in Adults and Children/Adolescents N=221 Adolescents/Children with AR N=476 Adults/Adolescents/Children with AR Patients with Moderate or Severe Impact (%) Patients with Impact (%) School/WorkPerformance NormalActivities Sleep Sleep DailyActivities School/WorkPerformance Lifestyle O’Connor and Punekar. J Allergy Clin Immunol. 2006;117:S322. Abstract 1244. Scadding and Punekar. EAACI Abstract Book. 2006;211. Abstract 741.

  5. Subjects with complaint (%) Difficulty FallingAsleep NocturnalAwakening EarlyAwakening NonrestorativeSleep Feeling ofLack of Sleep Snoring ESS score>10 Allergic Rhinitis Symptoms are Associated with Sleep Complaints Prevalence of Sleep Complaints in Patients with Allergic Rhinitis and Controls * * * * * * * *P<0.001 vs controls. Leger et al. Arch Intern Med. 2006;166:1744.

  6. * * * Subjects with disorder (%) * Insomnia SevereInsomnia Sleep ApneaSyndrome Hypersomnia Allergic Rhinitis (AR) Symptoms are Associated with Sleep Disorders Prevalence of Sleep Disorders in Patients with Allergic Rhinitis and Controls 7.6 fold increase of OSA in AR *P≤0.003 vs controls. Leger et al. Arch Intern Med. 2006;166:1744.

  7. Allergic Patients Experience More Apnea/Hypopnea than Non-allergic Controls Allergic patients had more apnea/hypopnea episodes than non-allergic controls P<0.001 AHI=apnea/hypopnea index, determined as the total number of apnea and hypopneaepisodes (assessed by polysomnography) divided by hours of sleep. Stuck et al. J Allergy Clin Immunol. 2004;113:663.

  8. Allergic Rhinitis is Associated with Increased Microarousals Patients with rhinitis had 10 times moremicroarousals (average of 50) than controls (n=14) Lavie et al. Acta Otolaryngol. 1981;92;529.

  9. Microarousals in Allergic Rhinitis Correlate with Impaired Breathing Microarousals Correlate with Impaired Breathing Lavie et al. Acta Otolaryngol. 1981;92;529.

  10. Obese man with severe OAS Increase in IL-1 Increase in TNF Increase in Il-6 Increase in T-helper 2 cytokines Decrease in T-helper 1 cytokines A young girl snoring and with rhinitis Increase in IL-1 Increase in TNF Increase in Il-6 Increase in T-helper 2 cytokines Decrease in T-helper 1 cytokines Similarities between the two

  11. What is the Mechanism of Sleep Disturbance in Allergic Rhinitis? • Inflammatory components of the allergic response • Symptoms of allergic rhinitis • Nasal congestion • All three Answer

  12. Impact of Poor Sleep • Impaired Social Functioning: • daytime fatigue/somnolence • Impaired performance • Impaired learning • Emotional/behavioral impact • Delayed onset • Sleep fragmentation • Arousals/microarousals • Sleep Disordered Breathing • Snoring • Obstructive Sleep Apnea • Associated Diseases: • Hypertension • Cardiovascular disease • Stroke • Diabetes • Psychological disorders

  13. Treatment Options

  14. Treatment Options:Snoring Children

  15. The approach to the child with concerns for having OSA

  16. The affect of OSA and benefits of T+A on asthma

  17. The affect of OSA and benefits of T+A on poorly controlled asthma

  18. Sleep apnea in children treated with topical budesonide nasal spray Kheirandish-Gozal. Pediatrics 2008

  19. Leukotrienes in tonsil tissue in children with sleep apnea (SA) and those with recurrent infection (RI) LTB-4 LTC-4

  20. Adenoid reduction with 16 weeks of montelukast therapy

  21. Montelukast affect on sleep in children with sleep apnea compared with those receiving no therapy

  22. Treatment Options for Rhinitis Associated With Sleep disordered Breathing

  23. Treatment Considerations in Allergic Rhinitis: ARIA Guidelines Bousquet et al. Allergy. 2003;58:192. Bousquet et al. Allergy. 2002;57:841. Van Cauwenberge etal. Allergy. 2000;55:116.

  24. Treatment Considerations in Allergic Rhinitis: ARIA Guidelines Bousquet et al. Allergy. 2003;58:192. Bousquet et al. Allergy. 2002;57:841. Van Cauwenberge etal. Allergy. 2000;55:116.

  25. Treatment Considerations in Allergic Rhinitis: ARIA Guidelines Bousquet et al. Allergy. 2003;58:192. Bousquet et al. Allergy. 2002;57:841. Van Cauwenberge etal. Allergy. 2000;55:116.

  26. Treatment Considerations in Allergic Rhinitis: ARIA Guidelines Bousquet et al. Allergy. 2003;58:192. Bousquet et al. Allergy. 2002;57:841. Van Cauwenberge etal. Allergy. 2000;55:116.

  27. Oral decongestants compared to placebo and benefit on sleep and rhinitis

  28. Oral decongestants compared to placebo and benefit on sleep and rhinitis

  29. Treatment Considerations in Allergic Rhinitis: ARIA Guidelines Bousquet et al. Allergy. 2003;58:192. Bousquet et al. Allergy. 2002;57:841. Van Cauwenberge etal. Allergy. 2000;55:116.

  30. Treatment Considerations in Allergic Rhinitis: ARIA Guidelines Bousquet et al. Allergy. 2003;58:192. Bousquet et al. Allergy. 2002;57:841. Van Cauwenberge etal. Allergy. 2000;55:116.

  31. Treatment Considerations in Allergic Rhinitis: ARIA Guidelines Bousquet et al. Allergy. 2003;58:192. Bousquet et al. Allergy. 2002;57:841. Van Cauwenberge etal. Allergy. 2000;55:116.

  32. Treatment Considerations in Allergic Rhinitis: ARIA Guidelines Bousquet et al. Allergy. 2003;58:192. Bousquet et al. Allergy. 2002;57:841. Van Cauwenberge etal. Allergy. 2000;55:116.

  33. Treatment Considerations in Allergic Rhinitis: ARIA Guidelines Bousquet et al. Allergy. 2003;58:192. Bousquet et al. Allergy. 2002;57:841. Van Cauwenberge etal. Allergy. 2000;55:116.

  34. Effect of Therapies for Allergic Rhinitis on Sleep and Quality of Life: Summary • Intranasal steroids provide significant relief of congestion and ocular symptoms and improve sleep in patients with allergic rhinitis • Non-sedating antihistamines and leukotriene receptor antagonists provide modest improvements in congestion, ocular, and nighttime symptoms • Decongestants effectively reduce congestion, but have minimal affect on sleep-disordered breathing

  35. Adverse Impact of Allergic Rhinitis on the Patient Quality of Life-Focus on Sleep: Conclusions • Allergic rhinitis is associated with impaired sleep • Sleep impairment in allergic rhinitis can be caused by • Inflammatory mediators • Nasal symptoms, primarily congestion and rhinorrhea • Ocular symptoms • Impaired sleep adversely affects performance, productivity and social functioning, and increases the risk of associated diseases • Intranasal steroids effectively target inflammation and relieve symptoms to provide improved sleep

  36. Thank you • Stephanie Teets • Stan Golden • Josh Berlin • Sujani Kukumanu • Katherine Hughs • Casey Glass • Joel Torretti • Faina Gurevich • Wenxin Wei • Jeff McCann • Chris Hanks • Carah Santos • Niti Sardana

  37. Questions Have a great day.

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