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Longitudinal Course of Sleep Disturbance and Relationship with Itch in Adult Atopic Dermatitis in Clinical Practice. (Manjunath J. et al., Dermatitis. 2022, Mar 3)
Atopic Dermatitis: The Story
This study examined the progression of sleep disturbance (SD) in adult individuals with atopic dermatitis (AD) over time: in particular, the longitudinal course of difficulty falling asleep and staying asleep were examined. The study also identified predictors of increased SD.
Why It’s Important
Atopic dermatitis is a chronic inflammatory skin condition that is associated with skin irritation including itch, scratch and pain and current estimates show that over 7% of Americans suffer from this condition.
SD is a common occurrence in individuals with AD, often due to the ongoing effects of skin irritation overnight disrupting normal sleep patterns. SD can contribute to further negative effects on the individual including poor mental health, headaches and behavioral problems which can substantially reduce the individual’s quality of life.
Therefore, reducing SD is a crucial step in the effective management of AD. In order to achieve this, factors that impact on quality of sleep must be identified so that patients can be supported effectively beyond the consulting room.
Thus far, most studies have looked at the impact of SD in children with AD, so this study aimed to assess the prevalence of SD in the adult population over time.
This prospective, dermatology practice-based study assessed individuals with atopic dermatitis (N=1295) on sleep disturbance measures. Patients were assessed at baseline and at follow-up visits, which occurred at approximately 6, 12, 18 and 24 months after baseline.
Measures for SD included the Patient-Reported Outcomes Information System (PROMIS) SD and Sleep-Related Impairment (SRI) questionnaires, as well as the Patient-Oriented Eczema Measure (POEM) questionnaire. These questionnaires were collectively used to assess AD severity, SD frequency and severity, frequency of difficulty falling asleep and/or staying asleep, and frequency of days with itch in the past week. Demographic information and patient history of comorbidities were also collected.
Overall, only 9.1% of patients had sustained improvement in sleep scores over time, as measured by the POEM questionnaire. The remaining patients experienced either sustained (21.1%) or fluctuating (69.8%) sleep disturbances over time.
Sleep disturbances can manifest as difficulty falling asleep or difficulty staying asleep. The results of this study have shown that difficulty staying asleep was a predominant challenge in this patient cohort: a greater proportion of patients experienced persistent difficulties staying asleep (31.4%) in comparison to falling asleep (17.7%), as shown using other SD measures.
Finally, the frequency of SD tended to increase with AD severity, adding to the results of previous studies. At baseline, 49.8% of AD patients experiencing 3 or more nights of SD in the past week had severe/very severe AD, 30.5% had moderate AD, and 19.7% had clear/mild AD, as measured by POEM scores. These numbers were also consistent with the percentage of patients who experienced persistent SD at the 2 follow-up visits.
Predictors of SD
Factors that increased risk of SD in AD patients included:
- Having a high baseline score for number of nights with disturbed sleep (3-6 nights or more)
- Having a high baseline score for number of days with itch (3-6 nights or more)
- Having overall severe to very severe atopic dermatitis
- Having hay fever as an additional comorbidity
The Key Takeaway
Based on this study, increased screening for SD by clinicians and the development of new interventions for SD are warranted and would likely improve the quality of life of individuals with AD.
Interventions focussing on the control of itch, the control of comorbidities such as hay fever, and the support of maintaining sleep are likely to have the most impact on patient wellbeing.
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