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Wise et al.

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over 6 months. 675,677 These RCTs show that over a 6-month period, both the placebo and treatment group experience clinically and statistically significantly improvements in generic and disease-specific QOL; however, the improvement is greater in the treatment arm. The AIT RCTs have longer follow-up periods (12 to 18 months) and show similar results, with placebo patients either staying at their baseline QOL impairment, or improving to a lesser degree than the treatment arms. 678,679 As expected in patients with SAR, QOL is better outside of peak season and worsens during allergen exposure. 690,691 • Aggregate Grade of Evidence: B (Level 1b: 11 studies; Level 2a: 2 studies; Level 2b: 16 studies; Level 2c: 1 study; Level 3b: 3 studies; Table VII.A.1). • Benefit: Successful management of AR leads to improved overall and disease specific QOL. • Harm: Management strategies for AR are associated with variable levels of harm and are further specified in Section IX. Management. • Cost: Management strategies for AR are associated with variable levels of cost and are further specified in Section IX. Management. • Benefits-Harm Assessment: The benefits of treating patients with AR to improve QOL may outweigh risks of treatment. • Value Judgments: Successful control of AR symptoms leads to important improvements in generic and disease specific QOL. • Policy Level: Recommend treatment of AR to improve QOL. • Intervention: AR patients may be offered various management strategies to improve general and disease-specific QOL. VII.A.2. Effect on sleep— Like generic and disease-specific QOL, validated tools exist for the assessment of sleep-related QOL in AR, but they are not always utilized in studies reported in the AR literature. Some studies evaluating generic and disease-specific QOL suggest that AR negatively impacts patients’ sleep 673,685,687 (Table VII.A.1). Several studies have specifically investigated the relationship between AR and sleep in adults and children (Table VII.A.2-1 and Table VII.A.2-2). The general conclusion from the aggregate data is that, like overall and rhinitis-specific QOL, AR negatively impacts sleep QOL and the successful treatment of AR reduces sleep disturbance. The overall quality of the data is higher for adults than for children. For the adult population, there is level 1b evidence supporting the conclusion that AR negatively impacts sleep. 705-709 These data deal with subjective reporting of daytime sleepiness, sleep quality, and symptoms usually through validated tools, in the setting of testing the effect of nasal corticosteroids and/or montelukast. Results demonstrate that AR patients have improvements in sleep quality and daytime sleepiness, in addition to sinonasal symptoms and QOL after treatment with nasal corticosteroids 705,706,709,710 or a combination of corticosteroids and montelukast. 709 Additionally AR has been associated with worse sleep fragmentation 711,712 and snoring. 713,714 Treatment of AR has been also suggested to also improve continuous positive airway pressure (CPAP) compliance in patients with OSA. 715 The data on the effects of AR on polysomnogram (PSG) parameters in adults is mixed. Most studies that included PSG

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Int Forum Allergy Rhinol . Author manuscript; available in PMC 2020 June 10.