Sleep Disturbance and Sleep-Related Impairment in Adults With Atopic Dermatitis: A Cross-sectional Study.

BACKGROUND Little is known about the impact of sleep disturbances (SD) or sleep-related impairment (SRI) in adults with AD or their relationship with severity of AD and itch and other predictors. OBJECTIVE The aim of this study was to determine the relationship between AD severity, SD, and SRI. METHODS We conducted a prospective online questionnaire-based study of 287 adults with AD, including assessment of AD severity by Patient-Oriented Eczema Measure, self-reported global AD severity, Self-Assessed Eczema Area and Severity Index and visual analog scale-itch, Patient-Reported Outcome Measurement Information System SD and SRI individual items, and T scores. RESULTS Adults with AD commonly endorsed all SD and SRI symptoms examined; only 58 (21.8%) reported having good or very good sleep quality in the past week. However, only a minority of adults with AD endorsed a more profound impact from these individual aspects of SD and SRI in the past week or Patient-Reported Outcome Measurement Information System T scores greater than 55. In particular, SD and SRI were associated with severe or very severe AD (Patient-Oriented Eczema Measure, self-reported severity, visual analog scale-itch, and/or Self-Assessed Eczema Area and Severity Index). Sleep-related impairment was also associated with comorbid hay fever and/or anxiety. CONCLUSIONS This study suggests that SD and SRI are common in adults with AD, particularly those with severe diseases. Sleep disturbances and SRI should be considered when assessing burden of AD and therapeutic decisions.

[1]  J. Silverberg,et al.  Validation of patient‐reported global severity of atopic dermatitis in adults , 2018, Allergy.

[2]  J. Silverberg,et al.  Burden of skin pain in atopic dermatitis. , 2017, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[3]  C. Flohr,et al.  When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council , 2017, Journal of the American Academy of Dermatology.

[4]  S. Tufik,et al.  Effects of acute sleep deprivation on state anxiety levels: a systematic review and meta-analysis. , 2016, Sleep medicine.

[5]  J. Silverberg,et al.  Burden of Sleep and Fatigue in US Adults With Atopic Dermatitis , 2016, Dermatitis : contact, atopic, occupational, drug.

[6]  J. Silverberg.  Association between childhood eczema and headaches: An analysis of 19 US population-based studies. , 2016, The Journal of allergy and clinical immunology.

[7]  J. Silverberg,et al.  Eczema is associated with osteoporosis and fractures in adults: a US population-based study. , 2015, The Journal of allergy and clinical immunology.

[8]  J. Silverberg,et al.  Eczema and cardiovascular risk factors in 2 US adult population studies. , 2015, The Journal of allergy and clinical immunology.

[9]  J. Ravenscroft,et al.  Translating Patient-Oriented Eczema Measure (POEM) scores into clinical practice by suggesting severity strata derived using anchor-based methods , 2013, The British journal of dermatology.

[10]  H. Nakagawa,et al.  Impact of disease severity on sleep quality in Japanese patients with atopic dermatitis. , 2013, Journal of dermatological science.

[11]  Fleur Fritz,et al.  Assessment of pruritus intensity: prospective study on validity and reliability of the visual analogue scale, numerical rating scale and verbal rating scale in 471 patients with chronic pruritus. , 2012, Acta dermato-venereologica.

[12]  S. Takeuchi,et al.  Visual analogue scale: evaluation of the instrument for the assessment of pruritus. , 2012, Acta dermato-venereologica.

[13]  J. Schmitt,et al.  EASI, (objective) SCORAD and POEM for atopic eczema: responsiveness and minimal clinically important difference , 2012, Allergy.

[14]  Daniel J Buysse,et al.  Development of Short Forms From the PROMIS™ Sleep Disturbance and Sleep-Related Impairment Item Banks , 2012, Behavioral sleep medicine.

[15]  M. Tashiro,et al.  Next-Day Residual Sedative Effect After Nighttime Administration of an Over-the-Counter Antihistamine Sleep Aid, Diphenhydramine, Measured by Positron Emission Tomography , 2010, Journal of clinical psychopharmacology.

[16]  Daniel J Buysse,et al.  Development and validation of patient-reported outcome measures for sleep disturbance and sleep-related impairments. , 2010, Sleep.

[17]  T. Craig,et al.  Assessing outcomes from the sleep disturbance associated with rhinitis , 2007, Current opinion in allergy and clinical immunology.

[18]  H. Williams,et al.  Measuring atopic eczema severity visually: which variables are most important to patients? , 2005, Archives of dermatology.

[19]  R. Kane,et al.  A comparison of the effect of diphenhydramine and desloratadine on vigilance and cognitive function during treatment of ragweed-induced allergic rhinitis. , 2003, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[20]  Bruce G. Bender,et al.  Actigraphy assessment of sleep disturbance in patients with atopic dermatitis: An objective life quality measure , 2003 .

[21]  S. Feldman,et al.  Use of the Self‐Administered Eczema Area and Severity Index by parent caregivers: results of a validation study , 2002, The British journal of dermatology.

[22]  H. Reuveni,et al.  Sleep fragmentation in children with atopic dermatitis. , 1999, Archives of pediatrics & adolescent medicine.

[23]  G. Stores,et al.  Physiological sleep disturbance in children with atopic dermatitis: a case control study. , 1998, Pediatric dermatology.

[24]  R. Dahl,et al.  Sleep disturbances in children with atopic dermatitis. , 1995, Archives of pediatrics & adolescent medicine.

[25]  Daniel J Buysse,et al.  The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research , 1989, Psychiatry Research.

[26]  J. Silverberg,et al.  Sleep disturbances in adults with eczema are associated with impaired overall health: a US population-based study. , 2015, The Journal of investigative dermatology.

[27]  J. Silverberg,et al.  Association between eczema and increased fracture and bone or joint injury in adults: a US population-based study. , 2015, JAMA dermatology.