Allergic rhinitis and its consequences on quality of sleep: An unexplored area.

BACKGROUND: Allergic rhinitis (AR) is common and has been shown to impair social life and sleep. Patients with severe symptoms may have more sleep disturbances than those with a mild form of the disease, but this has never been assessed using a validated tool. The objective of our study was to assess, in patients with AR, whether duration and severity of AR are associated with sleep impairment. METHODS: A nationwide controlled cross-sectional epidemiological study was carried out. A representative sample of 260 French ear, nose, and throat and allergy specialists enrolled 591 patients with AR of at least 1 year's duration. Sleep disorders, sleep quality, and AR were assessed using validated tools (Sleep Disorders Questionnaire, Epworth Sleepiness Scale, and Score for Allergic Rhinitis). The severity of AR was assessed using the Allergic Rhinitis and its Impact on Asthma classification. RESULTS: All dimensions of sleep were impaired by AR, particularly by the severe type. Sleep was significantly more impaired in patients with severe AR than in those with the mild type. The duration of AR (intermittent or persistent) had no effect on sleep. CONCLUSION: These data underline the close relationship between AR and sleep and highlight the need for clinicians, particularly general practitioners, to be attentive in this respect.

Nasal polyposis in France: impact on sleep and quality of life.

The prevalence of nasal polyposis (NP) in France (2.11 per cent) and its epidemiology (detection, medical management, patients' characteristics, risk factors, associated diseases, etc.) were determined in a population-based, cross-sectional, case-control study of 10 033 adults carried out in 2002. The impact of this disease on daily living was also studied, by the analysis of potential sleep disorders (validated questionnaire) and quality of life (QOL, SF-36 questionnaire) of NP patients, in a comparison with a matched-control group of individuals without NP. A quarter of NP patients (24.6 per cent) reported a feeling of general discomfort due to their nasal condition, during the day as well as the night in most of these cases (61.2 per cent). Compared with controls, NP patients have a two-fold higher risk of suffering sleep disturbance (odds ratio [OR]: 2.25, 95 per cent confidence interval [95% CI] [1.54; 3.29]). Snoring was reported by 50.5 per cent of NP patients vs 35.7 per cent of controls (p < 0.001). All scores from the SF-36 questionnaire demonstrated a significant negative impact of NP on the different aspects of QOL. The current study underlines the negative impact of NP on QOL and sleep, two dimensions that are rarely considered in its pathology. In addition to the discomfort and lowered QOL experienced by patients with this disease, a significant increase in sleep disorders was shown, suggesting a risk of suffering further chronic diseases and complications.

[Difficulties in the assessment of dyspnea and respiratory function in general practice]. / Difficultés de l'évaluation de la dyspnée et de la fonction respiratoire en médecine générale.

BACKGROUND: Dyspnea is one of the principal signs of chronic respiratory diseases. OBJECTIVE AND METHODS: To determine the appropriate questions and tests for recognizing dyspnea, 295 general practitioners questioned 1991 patients with or at risk of COPD in this cross-sectional study. After a brief training session, the physicians were asked to assess respiratory function with a small electronic spirometer. RESULTS: A questionnaire with a six-point semi-quantitative scale of dyspnea detected more dyspneic patients (78.1%) than the single question "Are you usually short of breath?" (68.6%), which in turn detected this symptom more often than simply listening for spontaneous complaints (33.7%). Even when dyspnea was reported only for substantial exertion, it was associated with impairment of all domains of quality of life. Only half the spirometry results met the minimal criteria of validity and reproducibility. DISCUSSION AND CONCLUSIONS: These results underline the importance of a specific, systematic assessment of dyspnea in patients at risk, and the need for sufficient training and practice before the use of electronic spirometers in general practice.