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Children with atopic dermatitis suffer from worse sleep quality

Tristan Manalac
14 Mar 2019

Atopic dermatitis appears to impair sleep quality, but not sleep duration, in children, particularly in those with more severe diseases, according to a new study.

“These findings suggest that clinicians should consider sleep quality among all children with atopic dermatitis, especially those with comorbid asthma or allergic rhinitis and severe disease; it appears interventions to improve sleep quality are needed for this population,” said researchers.

Researchers longitudinally evaluated sleep and self-reported AD in 13,988 children (51.7 percent male). Repeated measurements were collected from 1 year through 16 years of age. More than a third (35.3 percent; n=4,983) of the cohort were found to have AD, and these individuals were more likely to be female and have comorbid asthma or allergic rhinitis. [JAMA Pediatr 2019;doi:10.1001/jamapediatrics.2019.0025]

The mean night-time sleep duration ranged from 11.2±1.0 hours at 2 years of age to 8.7±0.9 hours at 16 years. In comparison, median daytime sleep duration was 30 minutes at 2 years, which dropped to 0 minutes thereafter.

Generally, night-time sleep was similar in duration in children with vs without AD. In adjusted multivariable mixed-effects linear regression models, the between-group difference was 0 minutes (95 percent CI, –2 to 2), with no meaningful alterations according to AD severity. For instance, the estimated difference for those with very bad (–1 minute; –6 to 3) and quite bad (0 minutes; –2 to 2) were likewise null.

In comparison, total sleep duration was significantly lower in those with AD (estimated difference, –2 minutes; –4 to 0), though the magnitude is unlikely to be of clinical significance.

In terms of sleep quality, half of the children (50.0 percent; n=5,075) reported waking up in the middle of the night at age 2 years, dropping to 13.5 percent (n=1,001) by age 10 years. From age 2–10 years, the prevalence rates for difficulty falling asleep ranged from 37.1 percent to 58.2 percent, while those for experiencing nightmares fell anywhere from 26.2 percent to 49.5 percent.

A cross-sectional analysis revealed that children with AD were significantly more likely to have worse sleep quality at all ages. In particular, those with active disease were 50-percent more likely to have more sleep disturbances than those who did not have AD (adjusted odds ratio [OR], 1.48; 95 percent CI, 1.33–1.66).

Moreover, comorbid asthma or allergic rhinitis amplified the effect of AD on sleep disturbance likelihood (p=0.04). Children who had AD with either condition had an 80-percent higher risk of having impaired sleep quality (adjusted OR, 1.79; 1.54–2.09). Meanwhile, those with only either asthma or allergic rhinitis were 40-percent more likely to experience sleep disturbances during childhood (adjusted OR, 1.42; 1.26–1.60).

“Clinicians caring for children with several atopic conditions should inquire about nocturnal symptoms and sleep disturbances during routine clinic visits and should consider treating these conditions more aggressively,” said researchers.

“Our findings support the development of standardized and validated clinical outcome measures of sleep disturbance that explicitly address several aspects of sleep quality. This refinement would enable future trials to assess the effectiveness of atopic dermatitis interventions in reducing poor sleep,” they added.

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