Abstract
BACKGROUND: The influence of circadian disruption from night shift work and poor sleep on allergic rhinitis (AR) risk remains inadequately characterized. The objective of this study was to advance the understanding of how circadian disruption influence AR risk, thereby providing new insights into the prevention and management of AR. METHODS: This prospective cohort study analyzed data from the UK Biobank, comprising 256,945 participants for shift work analysis and 374,672 for sleep pattern assessment. Shift work and sleep behaviors were self-reported at baseline. AR incidents were identified through linked hospital records. Multivariable Cox proportional hazards models were employed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Mediation analysis was conducted to assess the potential role of metabolic biomarkers. RESULTS: Irregular night shift work was associated with an increased risk of AR (HR = 1.21, 95% CI: 1.01–1.45), whereas permanent night shifts showed no clear association. Each categorical decrease in sleep pattern quality corresponded to a 16% increase in AR risk (HR = 1.16, 95% CI: 1.08–1.25). Specific unhealthy sleep behaviors—including evening chronotype, short sleep duration (≤ 6 h), insomnia, and snoring—were also associated with higher AR risk. Small HDL particle concentration partially mediated the association between sleep patterns and AR, accounting for 1.59% of the effect (95% CI: 0.12–5.28). CONCLUSION: Both irregular night shift work and poor sleep patterns are associated with an increased risk of AR, with small HDL particles acting as a partial mediator. These findings underscore the importance of maintaining circadian rhythm stability and improved sleep hygiene in the prevention and management of AR. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-026-26827-1.