Mediating role of sleep disturbance in association between nasal congestion severity and anxiety symptoms in allergic rhinitis patients

doi:10.5498/wjp.123481

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World Journal of Psychiatry

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2220-3206

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Psychiatry. Oct 19, 2026; 16(10): 123481
Published online Oct 19, 2026. doi: 10.5498/wjp.123481

Mediating role of sleep disturbance in association between nasal congestion severity and anxiety symptoms in allergic rhinitis patients

Jing Bai, Chao Kong, Yan-Ping Luo, Yin Li, Chao Zhang

Jing Bai, Yin Li, Chao Zhang, Department of Otorhinolaryngology, The First People’s Hospital of Foshan, Foshan 528000, Guangdong Province, China

Chao Kong, Yan-Ping Luo, Department of Anesthesiology, The First People’s Hospital of Foshan, Foshan 528000, Guangdong Province, China

Co-first authors: Jing Bai and Chao Kong.

Author contributions: Bai J and Kong C are co-first authors; Bai J and Kong C contributed to conceptualization, methodology, and investigation; Luo YP performed formal analysis and data curation; Li Y contributed to conceptualization, formal analysis, and data curation; Zhang C contributed to data curation, methodology, and writing original draft; all authors have read and approved the final manuscript.

AI contribution statement: The authors take full responsibility and accountability for all content of this manuscript, including any portions for which AI tools were used as assistive technologies. All AI-assisted outputs were carefully reviewed, validated, and approved by the authors. AI tools were not used to generate original scientific data, perform independent scientific analyses, or draw scientific conclusions.

Institutional review board statement: This study has been approved by the Institutional Review Board and Ethics Committee of the First People’s Hospital of Foshan, and in line with the principles of the Declaration of Helsinki.

Informed consent statement: As the data is de-identified and cannot be linked to a particular individual for harm or loss of privacy, consent is not required. Therefore, it has been permitted under the rules for late-stage study retrospectively.

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

Data sharing statement: The datasets in this paper can be obtained from the corresponding authors upon reasonable request.

Corresponding author: Chao Zhang, MD, Researcher, Department of Otorhinolaryngology, The First People’s Hospital of Foshan, No. 81 Lingnan Avenue North, Chancheng District, Foshan 528000, Guangdong Province, China. fsyyyent@163.com

Received: May 22, 2026
Revised: June 24, 2026
Accepted: July 28, 2026
Published online: October 19, 2026
Processing time: 144 Days and 3 Hours

Abstract

BACKGROUND

Nasal congestion in allergic rhinitis (AR) is commonly associated with sleep disturbances, which may be linked to negative emotional states such as anxiety.

AIM

To investigate the statistical associations between nasal congestion severity, sleep disorders, and anxiety levels in patients with AR.

METHODS

This retrospective cross-sectional study included 235 patients diagnosed with AR between January 2020 and June 2023. Patients were stratified into a severe nasal congestion (SNC) group [Visual Analog Scale (VAS) score ≥ 7] and a moderate nasal congestion (MNC) group (VAS score 4-6). Data on demographics and clinical characteristics were collected. Assessments included the nasal congestion VAS, the Pittsburgh Sleep Quality Index (PSQI) alongside self-reported sleep symptoms, the Generalized Anxiety Disorder 7-item Scale (GAD-7), and the Cuestionario ESPañol de Calidad de Vida en RINiTis-15 quality of life questionnaire.

RESULTS

The PSQI of the SNC group were significantly higher (indicating worse sleep quality) than those in the MNC group (10.24 ± 3.19 vs 9.05 ± 2.12, P < 0.001), and more sleep symptoms were reported by the SNC group (all P < 0.05). The SNC group also exhibited higher anxiety scores (GAD-7: 8.47 ± 2.63 vs 6.82 ± 1.95, P < 0.001) and a greater proportion of patients with clinically significant anxiety symptoms (81.7% vs 65.2%, P = 0.004). Correlation analysis revealed significant positive associations between nasal congestion severity, sleep disturbance, and anxiety symptoms (all P < 0.001). Exploratory statistical mediation analysis suggested that sleep disturbances accounted for a significant proportion (67.20%, indirect effect β = 0.352, 95% confidence interval: 0.259-0.452) of the observed association between nasal congestion severity and anxiety. This analysis was exploratory and adjusted for age and gender as potential confounders.

CONCLUSION

In this retrospective cohort, sleep disturbance demonstrated a statistically significant partial mediating role in the observed cross-sectional association between nasal congestion severity and anxiety symptoms among patients with AR, highlighting these interconnected domains for comprehensive clinical management. These hypothesis-generating findings require validation in prospective longitudinal studies.

Keywords: Rhinitis; Allergic; Nasal obstruction; Sleep disorders; Anxiety; Mediation analysis

Core Tip: This cross-sectional study of 235 allergic rhinitis patients found that sleep disturbance statistically mediated 67.2% of the observed association between nasal congestion severity and anxiety symptoms. The findings highlight that allergic rhinitis is not merely a local nasal disease but has systemic associations affecting sleep and mental health. Managing sleep disturbance may be as important as treating nasal congestion to reduce anxiety in allergic rhinitis patients. These hypothesis-generating results require prospective validation.