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

Table 1 Comparison of demographic characteristics between the two groups, mean ± SD/n (%)

Parameters	MNC group (n = 115)	SNC group (n = 120)	t/χ2 value	P value
Age (years)	38.95 ± 7.32	39.68 ± 7.45	0.764	0.446
Gender			0.030	0.863
Male	61 (53.04)	65 (54.17)
Female	54 (46.96)	55 (45.83)
BMI (kg/m2)	23.21 ± 3.04	23.63 ± 3.22	1.010	0.314
Education level			0.667	0.414
High school and below	41 (35.65)	49 (40.83)
University and above	74 (64.35)	71 (59.17)
Employment status			0.799	0.371
Working/studying	98 (85.21)	97 (80.83)
Retired/unemployed	17 (14.79)	23 (19.17)
Drinking history	25 (21.74)	28 (23.33)	0.085	0.770
Smoking history	18 (15.65)	20 (16.67)	0.045	0.833

MNC: Moderate nasal congestion; SNC: Severe nasal congestion; BMI: Body mass index.

Table 2 Comparison of disease and clinical characteristics between the two groups, mean ± SD/n (%)

Parameters	MNC group (n = 115)	SNC group (n = 120)	t/χ2 value	P value
Disease duration (years)	5.87 ± 1.84	6.31 ± 2.01	1.782	0.076
AR type			0.624	0.430
Perennial	70 (60.87)	79 (65.83)
Seasonal	45 (39.13)	41 (34.17)
Sensitization profile
Dust mites	98 (85.22)	108 (90.00)	1.242	0.265
Pollen	65 (56.52)	75 (62.50)	0.871	0.351
Molds	22 (19.13)	35 (29.17)	3.220	0.073
Animal dander	18 (15.65)	25 (20.83)	1.054	0.304
Family history of allergies	68 (59.13)	80 (66.7)	1.430	0.232
Nasal congestion VAS score	5.15 ± 0.32	8.26 ± 0.52	55.243	< 0.001

MNC: Moderate nasal congestion; SNC: Severe nasal congestion; AR: Allergic rhinitis; VAS: Visual Analog Scale.

Table 3 Comparison of sleep quality between the two groups, mean ± SD

Parameters	MNC group (n = 115)	SNC group (n = 120)	t value	P value
Global PSQI score	9.05 ± 2.12	10.24 ± 3.19	3.371	< 0.001
Subjective sleep quality	1.36 ± 0.40	1.51 ± 0.48	2.517	0.013
Sleep latency	1.53 ± 0.41	1.71 ± 0.52	2.914	0.004
Sleep duration	1.23 ± 0.34	1.38 ± 0.40	3.103	0.002
Habitual sleep efficiency	1.04 ± 0.27	1.18 ± 0.39	3.164	0.002
Sleep disturbances	1.63 ± 0.56	1.84 ± 0.51	2.996	0.003
Use of sleeping medication	0.47 ± 0.15	0.50 ± 0.15	1.193	0.234
Daytime dysfunction	1.46 ± 0.38	1.63 ± 0.49	3.039	0.003

MNC: Moderate nasal congestion; SNC: Severe nasal congestion; PSQI: Pittsburgh Sleep Quality Index.

Table 4 Comparison of patient sleep related symptoms (self-reported by oneself or family members) between the two groups, n (%)

Parameters	MNC group (n = 115)	SNC group (n = 120)	χ2 value	P value
Waking up at night due to nasal congestion ≥ 1	42 (36.52)	76 (63.33)	16.886	< 0.001
Mouth breathing	50 (43.48)	85 (69.17)	17.976	< 0.001
Snoring	57 (49.57)	77 (64.17)	5.109	0.024
Waking up in the morning with mouth and tongue dry	60 (52.17)	87 (72.50)	10.357	0.001
Feeling tired and unable to recover energy in the morning	67 (58.26)	92 (76.67)	9.092	0.003
Daytime drowsiness affecting work or life	49 (42.61)	73 (60.83)	7.813	0.005

MNC: Moderate nasal congestion; SNC: Severe nasal congestion.

Table 5 Correlation analysis of nasal congestion, sleep, and anxiety scores

Parameters	Nasal congestion VAS score	Global PSQI score	Global GAD-7 score
Nasal congestion VAS score	1	0.582	0.423
Global PSQI score	0.582	1	0.616
Global GAD-7 score	0.423	0.616	1

The values in the table are Pearson correlation coefficients r, with all P values < 0.001. VAS: Visual Analog Scale; PSQI: Pittsburgh Sleep Quality Index; GAD-7: Generalized Anxiety Disorder 7-item Scale.

Table 6 Mediation effect of sleep disorders between nasal congestion and anxiety in patients with allergic rhinitis

Parameters	β	SE	P value	95%CI	Effect proportion (%)
Total effect (nasal congestion to1 anxiety)	0.524	0.076	< 0.001	0.375-0.673	100.00
Mediation path 1 (nasal congestion to1 sleep disorder)	0.641	0.057	< 0.001	0.529-0.753
Mediation path 2 (sleep disorder to1 anxiety)	0.587	0.062	< 0.001	0.465-0.709
Direct effect (nasal congestion to1 anxiety)	0.172	0.068	0.012	0.038-0.306	32.80
Indirect effect (nasal congestion to1 sleep disorder to1 anxiety)	0.352	0.049	< 0.001	0.259-0.452	67.20

¹Represent statistical associations, not causal pathways.

Model adjusted for age and gender. CI: Confidence interval.