Fall/Winter 2011

I would like to announce the integration of allergy medicine at the Sleep Institute of New England. As the accompanying abstracts identify, there is an association between impairments in sleep and allergies. As always, my staff and I are committed to providing high quality care in diagnosing, testing and treating patients. I look forward to implementing the new allergy program at my practice.

I encourage open communication to optimally treat your patients. I appreciate your support and look forward to building a trusting relationship with you and your patients.

Please contact us  and let us know if there is any topic of interest you would like more information about.


Elizabeth A. Lynch, MD


Role of allergy In sleep-disordered breathing.

Otolaryngol Clin North Am. 2011 Jun;44(3):625-35, viii. Epub 2011 May 2.

Sleep-related symptoms are extremely common in patients with allergic rhinitis. Sleep impairment is likely a major contributor to the overall disease morbidity, direct and indirect health care costs, and the loss of work productivity associated with allergic rhinitis. The association between allergic rhinitis and sleep, and the subsequent impact on disease-specific and general health quality of life measures, is well documented in large epidemiologic studies as well as controlled clinical trials. This article focuses on sleep disruption caused by allergic rhinitis, and the therapeutic and surgical options available to tackle the problem.


Assessment of sleep impairment in persistent allergic rhinitis patients using polysomnography.

Int Arch Allergy Immunol.2011;155(1):57-62. Epub 2010 Nov


Although questionnaires have demonstrated an association between impairment of quality of sleep and symptoms in allergic rhinitis (AR) patients, to date there is no report of an objective assessment of sleep in patients with persistent allergic rhinitis (PER) as defined by ARIA guidelines. The aim of the present study was therefore to assess sleep disturbance in PER patients by polysomnography (PSG).


Ninety-eight PER patients with moderate-to-severe nasal obstruction and 30 healthy volunteers were included in the study. All patients underwent PSG during nocturnal sleep to assess the presence and severity of sleep disorders. Peak nasal inspiratory flow (PNIF) was also measured to assess nasal resistance.


There were statistically significant, though clinically modest, differences between PER patients and healthy controls in most PSG parameters including sleep efficiency, arousal index, average SaO(2), lowest SaO(2), time spent with a saturation below 90%, and snoring time. Although the apnea-hypopnea index (AHI) was not significantly different between the 2 groups, 17 subjects (17.3%) in the PER group but none of the control subjects had an AHI >5. Patients with higher T5SS scores (12 ≤T5SS ≤15) had a greater tendency to snore than did patients with lower

scores (8 ≤T5SS ≤11). Finally, PNIF in the PER group was significantly lower than in the control group. Weak corre- lations between the arousal index and PNIF, average SaO (2), and PNIF were found.


PSG showed modest changes in PER patients versus control subjects.


Asthma-related comorbidities.

Boulet LP, Boulay MÈ. Expert Rev Respir Med. 2011 Jun;5(3):377-93.

Asthma is often associated with various comorbidities. The most frequently reported asthma comorbid conditions include rhinitis, sinusitis, gastroesophageal reflux disease, obstructive sleep apnea, hormonal disorders and psychopathologies. These conditions may, first: share a common pathophysiological mechanism with asthma; second: influ- ence asthma control, its phenotype and response to treatment; and third: be more prevalent in asthmatic patients but without obvious influence on this disease. For many of these, how they interact with asthma remains to be further documented, particularly for severe asthma. If considered relevant, they should, however, be treated appropriately. Further research is needed on the relationships between these conditions and asthma.


Allergic respiratory disease as a potential co-morbidity for hypertension.

Aung T, Bisognano JD, Morgan MA. Cardiol J. 2010;17(5):443-7.

This article examines the relationships between allergic rhinitis and hypertension, chronic sinusitis and hyperten- sion, and asthma and hypertension. Previous studies have demonstrated that men reporting seasonal or chronic rhinitis had on average a 3.5 mm Hg higher systolic blood pres- sure than those without allergic rhinitis. Proposed mechanisms to the relationship between allergic rhinitis and sinusitis with hypertension may lie in the pathway of obstructive sleep apnea via neurohumoral responses to hypoxemia. Asthmatics were 1.4 times more likely to have heart disease, and 1.3 times more likely to have high blood pressure, than non-asthmatics. The commonality of immunological dysfunction and inflammation between diseases of allergy and those mediated by hypertension and other vascular disorders may explain the correlations observed. Interestingly, obese individuals have higher levels of circulating IL-6, leptin and TNF-alpha skewing the immune system toward the allergen-reactive type 2 helper T-cell. This would mean that obese individuals were predisposed to diseases of chronic inflammation. The implications of allergic rhinitis, chronic sinusitis, and asthma deserve closer attention, especially into the possibility of co-morbidity for hypertension. Although associations between allergic diseases and hypertension have been reported, more studies need to be performed to elucidate the mechanisms behind such associations.


The prevalence of allergic rhinitis in patients with simple snoring and obstructive sleep apnea syndrome.

Kulak Burun Bogaz Ihtis Derg. 2011 Mar-Apr;21(2):70-5. doi: 10.5606/kbbihtisas.2011.002.


This study aims to investigate the prevalence of allergic rhinitis and the relation between allergic rhinitis and the development of obstructive sleep apnea syndrome (OSAS) and OSAS severity in patients with simple snoring and OSAS.


A total of 80 patients (51 males, 29 females; mean age 45.4±8.1 years; range 18 to 69 years) who were admitted to our clinic with the complaints of snoring and nocturnal awakening and diagnosed with simple snoring and OSAS were included in the study and divided into four groups ac- cording to apnea-hypopnea indexes (AHIs) scores. The patients were interrogated about the presence of allergic rhini- tis. Radioallergosorbent test (RAST) and prick tests were performed.


We found allergic rhinitis in 18 of the 80 (23%) patients. The house mites were found to be the causative allergen in 13 of the 18 (72%) patients.


We recommend that the allergy symptoms such as nasal obstruction and sneezing should be added to the questions that are asked to the patients with simple snoring and OSAS and that the investigations should include the skin prick and RAST tests in these patients.


The nose, snoring and obstructive sleep and obstructive sleep apnoea.

Kotecha B. Rhinology. 2011 Aug; 49(3) :259-63

Snoring and obstructive sleep apnoea are both due to multilevel anatomical obstruction, and the nose and nasal pathology both contribute in many cases. This paper addresses some of the issues surrounding the problem and briefly discusses the role of medication and nasal dilators and in more detail the implication of nasal surgery in various aspects of sleep related breathing disorders (SRBD). Nasal obstruction leads to mouth breathing, which destabilises the upper airway and aggravates SRBD.


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