[Frontiers in Bioscience S2, 30-46, January 1, 2010]

Disturbed sleep: linking allergic rhinitis, mood and suicidal behavior

Beverly J Fang1, 2, Leonardo H. Tonelli1, Joseph J.Soriano1, Teodor T. Postolache1

1Mood and Anxiety Program (MAP), Department of Psychiatry, University of Maryland School of Medicine, 685 West Baltimore Street MSTF Building Room 930, Baltimore, MD 21201 USA, 2University of Maryland/Sheppard Pratt Psychiatry Residency Program, 22 South Greene Street, Baltimore, MD 21201 USA


1. Abstract
2. Introduction
3. Sleep
4. Neurochemistry of sleep
4.1. Serotonin
4.2. Norepinephrine and histamine
4.3. Orexins
4.4. Cytokines
5. Cytokines, depression and suicide
6. Allergic rhinitis, impaired sleep, and suicide
6.1. Association between seasonal allergies and suicides
6.2. Sleep and daytime alertness is adversely affected by untreated allergic rhinitis
6.3. Treatment of allergic rhinitis improves sleep
6.4. Disrupted sleep in patients with allergic rhinitis may increase risk of suicide
7. Sleep, depression and suicide
7.1. Sleep and psychiatric disorders: epidemiological and clinical evidence
7.2. Sleep architecture in patients with psychiatric disorders
8. Sleep disturbances and suicidality
8.1. Shortening of sleep duration; insomnia, sleep fragmentation
8.2. Hypersomnia
8.3. Nightmares
8.4. Nocturnal panic attacks
9. Concluding remarks
10. Acknowledgements
11. References


Recent research has consistently shown an association between inflammation and sleep, with Th1 cytokines promoting NREM sleep and increasing sleepiness and Th2 cytokines (produced during allergic inflammation) impairing sleep. As sleep impairment is considered a treatable suicide risk factor strongly associated with mood disorders, we review the literature leading to the hypothesis that allergic rhinitis may lead to mood and anxiety disorders and an increased risk of suicide via worsening sleep. Allergic rhinitis can impair sleep through mechanical (obstructive) and molecular (cytokine production) processes. The high prevalence of mood and anxiety disorders and allergy, the nonabating suicide incidence, the currently available treatment modalities to treat sleep impairments and the need for novel therapeutic targets for mood and anxiety disorders justify multilevel efforts to test and better understand this pathophysiological link where, relatively limited if timely, interventions may have large beneficial effectgs. .