Pollen Levels on the Day of Polysomnography Influence Sleep Disordered Breathing Severity in Children with Allergic Rhinitis

Purpose: Allergic rhinitis (AR) is a common risk factor for sleep disordered breathing (SDB) in children. Allergy to pollen is a trigger for allergic rhinitis, causing nasal inflammation, upper airway congestion and obstruction. We aimed to determine if the pollen count on the day of diagnostic polysomnography for SDB affected the result.

Methods: Children (3-18 years; n = 90) who participated in research studies between 1 October and 31 December, when daily regional pollen counts were available, in the years 2005-2016 were eligible for inclusion. All children underwent overnight polysomnography for assessment of SDB severity. Pollen was categorised as grass or other pollen. Multiple stepwise linear regression was performed to determine whether the pollen count for that day, a diagnosis of asthma, age, and BMI-z-score were determinants of respiratory parameters measured on polysomnography, including the obstructive apnoea hypopnoea index (OAHI), SpO nadir, average SpO drop, SpO < 90%, oxygen desaturation index > 4% (ODI4), and average transcutaneous CO (TCM).

Results: Sixteen/90 children had AR. In children with AR, an increase in grass pollen of 1 grain/m predicted an increase in OAHI of 0.2 events/h, ODI4 of 0.18 times/h, SpO < 90% of 0.03 times/h, and TCM of 0.07 mmHg. None of the factors were determinants of SDB severity in children without AR.

Conclusion: Our findings highlight that daily pollen counts may be an important factor influencing the severity of SDB on a single night of polysomnography in children with clinical allergic rhinitis and should be taken into account when determining treatment options.