Sleep disturbance common among children with atopic dermatitis

Sleep disturbance appeared common among school-aged children with atopic dermatitis and may be associated with neuropsychiatric impairment, according to a study published in The Journal of Allergy and Clinical Immunology: In Practice.

“Clinicians should screen for these symptoms in school-aged children, particularly with moderate-to-severe atopic dermatitis,” Anna B. Fishbein, MD, MS, researcher in the department of pediatrics and allergy-immunology at Northwestern University Feinberg School of Medicine, and colleagues wrote.

Although it is known that atopic dermatitis is associated with sleep disturbance, not much is known about the epidemiology.

Investigators conducted a cross-sectional survey of 180 parent-child dyads with atopic dermatitis to estimate the U.S. prevalence of sleep disturbance and its impact on psychological and neurocognitive function. All children were aged 5 years to 17 years.

Researchers stratified the sampling based on age and race as well as disease severity, rated as mild (n = 30), moderate (n = 75) or severe (n = 75) according to the Patient Oriented Eczema Measure. They additionally used the Patient Reported Outcome Measurement Information System to assess symptoms of sleep and psychological health, and they estimated the prevalence of sleep disturbance by calculating weighted frequencies using data from the 2007 National Survey of Children’s Health.

Overall, a weighted 66.9% (95% CI, 53.3-80.5) of the overall study population had parent-proxy reported sleep disturbance and 61.2% (95% CI, 46.8-75.5) had sleep-related impairment.

Researchers found similar levels of sleep disturbance among Black and white children after adjusting for disease severity (adjusted OR = 1.51; 95% CI, 0.65-3.5).

Predictors for parent-proxy reported sleep disturbance included itch intensity (adjusted = 1.33; 95% CI, 0.62-2.04) and low-income levels (< $50,000: adjusted = 6.64; 95% CI, 2.05-11.23 vs. $50,000 to < $100,000: adjusted = 4.75; 95% CI, 0.35-9.14).

Results of bivariable logistic regression models also showed the odds for severe sleep disturbance increased among those with moderate (OR = 2.03; 95% CI, 1-4.1) and severe atopic dermatitis (OR = 8.68; 95% CI, 1.82-41.49) compared with mild disease.

After controlling for atopic dermatitis severity, itch intensity and significant socio-demographics, researchers observed an association between parent-proxy reported sleep disturbance and increased severity of sleep-associated impairment (OR = 1.46; 95% CI, 1.24-1.72), depression (OR = 1.19; 95% CI, 1.08-1.31), fatigue (OR = 1.28; 95% CI, 1.14-1.45) and anxiety (OR = 1.29; 95% CI, 1.13-1.46).

Children who self-reported sleep disturbance had increased odds for sleep-related impairment (OR = 1.2; 95% CI, 1.11-1.29), depression (OR = 1.13; 95% CI, 1.03-1.24), fatigue (OR = 1.28; 1.06-1.54) and anxiety (OR = 1.16; 95% CI, 1.02-1.31).

Limitations of the study included the fact that disease severity and assessments were based on parent-proxy or patient report and objective data were not available; the study was limited to cross-sectional data, making the longitudinal impact of atopic dermatitis on sleep indeterminable; and population-based estimates have inherent limitations as they were not sampled directly and were extrapolated from older 2007 data.

“Our ongoing work focuses on uncovering the mechanism of sleep disturbance in atopic dermatitis to develop more targeted treatment approaches,” the researchers wrote. “In the meantime, we refer clinicians to our previously published algorithm to screen, assess and treat sleep disturbance in children with atopic dermatitis.”