Auris, nasus, larynx · 2026
Sleep disturbance mediates the impact of pediatric allergic rhinitis on caregiver burden: A large-scale structural analysis.
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Hyo Yukiyoshi, Miyake Hironori, Yokoyama Ayaka, Fukuda Yujiro, Kanda Eiichiro, Kariya Shin, Hara Hirotaka
Аннотация
OBJECTIVE: Although pediatric allergic rhinitis (AR) is known to impair quality of life (QOL), the structural mechanisms connecting nasal symptoms to caregiver burden are not fully understood. We aimed to clarify the "negative cascade" of pediatric AR, focusing on sleep disturbance as a core mediator between symptoms and psychosocial impairments.
METHODS: This study analyzed data from 2361 children (mean age: 5.6 years). We used the Japanese Rhinoconjunctivitis Quality of Life Questionnaire (JRQLQ) and the OSA-18 to assess nasal symptoms (TNSS), sleep disturbance, emotional functioning, daily life activities, and caregiver concerns. Hierarchical multiple regression and structural equation modeling (SEM) were performed.
RESULTS: AR prevalence was 28.8% (n = 681). Children with AR showed significantly higher scores across all OSA-18 domains (all p < 0.001, effect sizes d=0.21-0.61). SEM confirmed that nasal symptoms (β = 0.382) strongly predicted sleep disturbance (β = 0.244). Critically, hierarchical regression revealed that sleep disturbance strongly predicted emotional symptoms (β = 0.393, ΔR²=0.143) and daytime function (β = 0.311, ΔR²=0.091) after controlling for nasal symptoms. Sleep's effect was 2-3 times larger than direct effects of nasal symptoms (emotional: ratio=2.26; daytime: ratio=2.93). When all pathways were examined simultaneously, sleep (β = 0.205), emotional symptoms (β = 0.315), and daytime function (β = 0.288) all contributed independently to caregiver concerns, explaining 46.8% of variance. Sequential mediation showed that more than half (54.5%) of the total indirect effect of TNSS on caregiver concerns operates through sleep-mediated pathways.
CONCLUSIONS: Sleep disturbance emerged as the dominant mediating pathway, substantially amplifying the functional impact of nasal symptoms. Early interventions should prioritize restoring sleep quality for cascading benefits across emotional, behavioral, and family domains.
METHODS: This study analyzed data from 2361 children (mean age: 5.6 years). We used the Japanese Rhinoconjunctivitis Quality of Life Questionnaire (JRQLQ) and the OSA-18 to assess nasal symptoms (TNSS), sleep disturbance, emotional functioning, daily life activities, and caregiver concerns. Hierarchical multiple regression and structural equation modeling (SEM) were performed.
RESULTS: AR prevalence was 28.8% (n = 681). Children with AR showed significantly higher scores across all OSA-18 domains (all p < 0.001, effect sizes d=0.21-0.61). SEM confirmed that nasal symptoms (β = 0.382) strongly predicted sleep disturbance (β = 0.244). Critically, hierarchical regression revealed that sleep disturbance strongly predicted emotional symptoms (β = 0.393, ΔR²=0.143) and daytime function (β = 0.311, ΔR²=0.091) after controlling for nasal symptoms. Sleep's effect was 2-3 times larger than direct effects of nasal symptoms (emotional: ratio=2.26; daytime: ratio=2.93). When all pathways were examined simultaneously, sleep (β = 0.205), emotional symptoms (β = 0.315), and daytime function (β = 0.288) all contributed independently to caregiver concerns, explaining 46.8% of variance. Sequential mediation showed that more than half (54.5%) of the total indirect effect of TNSS on caregiver concerns operates through sleep-mediated pathways.
CONCLUSIONS: Sleep disturbance emerged as the dominant mediating pathway, substantially amplifying the functional impact of nasal symptoms. Early interventions should prioritize restoring sleep quality for cascading benefits across emotional, behavioral, and family domains.