A majority of adult patients with atopic dermatitis and sleep disturbance experience improvement in their sleep over time, according to the results of a study reported in Dermatitis. The study authors also found that hay fever, disease severity, and itch frequency are predictive of increased sleep disturbance over time.
The longitudinal study assessed the progression of sleep disturbance among adult patients with atopic dermatitis, as well as predictors of increased sleep disturbance.
Participants aged 18 years and older were enrolled from an eczema clinic at an academic medical center and completed electronic questionnaires from 2014 to 2019. The patients received standard-of-care follow-up and treatment and were assessed at baseline and at approximately 6, 12, 18, and 24 months.
Outcome measures included the Patient-Reported Outcomes Information System (PROMIS) SD and Sleep-Related Impairment (SRI) 8-item short-form questionnaires and the Patient-Oriented Eczema Measure (POEM).
A total of 1295 participants were included in the study; 40.5% had clear/mild atopic dermatitis, 35.1% had moderate atopic dermatitis, and 24.4% had severe/very severe atopic dermatitis. Among the cohort, 86.6% of patients were aged 18 to 64 years, 67% were White, and 90.3% were women.
At baseline, 34.2% of participants reported experiencing at least 3 nights of SD associated with eczema during the previous 7 days; 19.1% had difficulty falling asleep, and 22.9% had difficulty staying asleep. According to PROMIS SD T scores, 16.9% of study participants were considered to have severe sleep disturbance.
Among study participants who experienced at least 3 nights of sleep disturbance as a result of atopic dermatitis within the previous week at baseline, 31.5% reported sleep disturbance at the initial follow-up, and 12.3% reported persistent sleep disturbance at the first and second follow-up visits. A comparable proportion of patients who had difficulty staying asleep at baseline reported persistent difficulty falling asleep during the first (30.9%) and second (12.2%) follow-up visits. Of the patients who had severe sleep disturbance at baseline according to PROMIS SD T scores, 23.0% and 11.5% had scores reflecting a persistent course of sleep disturbance at the first and second follow-up visits, respectively.
Among other findings, 21.1% of patients had persistent, 69.8% had fluctuating improvement, and 9.1% had sustained improvement in POEM sleep scores over time. A higher proportion of participants (31.4%) reported experiencing persistent difficulty staying asleep vs those experiencing difficulty falling asleep (17.7%).
Substantial fluctuation in POEM sleep scores, difficulty falling asleep, and difficulty staying asleep occurred over time. Having severe/very severe atopic dermatitis (adjusted odds ratio [aOR], 7.69; 95% CI, 3.88-15.26) and always having difficulty falling asleep at baseline (aOR, 28.33; 95% CI, 15.59-51.50) were associated with greater difficulty in falling asleep over time.
Factors predictive of increased nights of sleep disturbance as a result of atopic dermatitis included having 3 to 6 nights (aOR, 26.08; 95% CI, 15.15-44.92) or 7 nights (aOR, 21.18; 95% CI, 11.42-39.28) of sleep disturbance associated with atopic dermatitis at baseline, having 3 to 6 days (aOR, 94.68; 95% CI, 20.06-447.04) or 7 days (aOR, 84.83; 95% CI, 17.35-414.67) of itch, and overall severe/very severe atopic dermatitis (aOR, 16.20; 95% CI, 7.92-33.13).
Increased PROMIS SD T scores over time were associated with baseline PROMIS SD T score (adjusted β, 0.66; 95% CI, 0.60-0.72), overall severe/very severe atopic dermatitis (adjusted β, 6.27; 95% CI, 4.50-8.05), and a history of hay fever (adjusted β, 2.07; 95% CI, 0.72-3.42). Increased PROMIS SRI T scores over time were associated with baseline PROMIS SRI T scores (adjusted β, 0.74; 95% CI, 0.68-0.80), 3 to 6 nights of itch (adjusted β, 2.22; 95% CI, 0.85-3.59), and severe/very severe atopic dermatitis (adjusted β, 4.40; 95% CI, 2.60-6.20).
Among several study limitations, objective assessments of signs of atopic dermatitis and sleep disturbance were not conducted in the single-center study. Also, a number of patients were lost to follow-up or did not complete all assessments, and a control group of patients without atopic dermatitis was not included in the analysis.
Study authors conclude that sleep disturbance experienced by patients with atopic dermatitis decreases over time, and factors contributing to persistent sleep disturbance include severity of sleep disturbance at baseline and presence of hay fever, as well as frequency and severity of itch. “Based on this study, increased screening for SD and the development of optimal interventions for SD in patients with AD are warranted,” stated the investigators.
Disclosure: This research was supported in part by an unrestricted research grant from Galderma, and 2 of the study authors are employees of Galderma.
Manjunath J, Lei D, Ahmed A, et al. Longitudinal course of sleep disturbance and relationship with itch in adult atopic dermatitis in clinical practice. Dermatitis. 2023;34(1):42-50. doi: 10.1089/DERM.0000000000000859