Reviews and feature articleSleep disorders and atopic dermatitis: A 2-way street?
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Sleep disorders in patients with AD
Sleep disturbance is reported in 47% to 80% of children with AD and in 33% to 87.1% of adults with AD (Table I).1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21 The majority of studies in the literature describing sleep disturbance in patients with AD are based on questionnaires of subjective sleep problems. The most commonly reported sleep problems in both children and adults with AD include difficulty falling asleep, frequent nighttime awakenings, and excessive
Effect of sleep disorders on patients with AD
After itch, sleep disturbance has been ranked as the second highest factor leading to impaired quality of life in children with AD.12 Children with AD have been reported to have lower quality of life than children with other chronic skin diseases, such as psoriasis, urticaria, and acne, and also other chronic diseases, such as renal disease, asthma, cystic fibrosis, epilepsy, and diabetes.33
The quality of life and sleep of family members are also affected by childhood AD. In parents of children
Mechanism of sleep disorders in patients with AD
The pathogenesis of sleep disturbance in patients with AD is complex and not fully understood but likely involves several contributing factors.42 Several studies have shown that disease severity is associated with sleep disturbance in children with AD.3, 15 Pruritus and scratching movements disrupting sleep seem to be the most straightforward reason for sleep disturbance in children with AD because the itch in these patients is often worse at night. The cause of itch in patients with AD has
Do sleep disorders exacerbate AD?
Scratching leads to tissue damage and release of structural proteins, triggering an IgE response and resulting in an itch-scratch cycle that exacerbates AD.1 Studies have found that in patients with AD, scratching occurs mainly in stage N1 sleep but is also not much suppressed during the deeper N2 and N3 sleep stages, when there is usually very little limb movement in healthy control subjects.15, 52 Compared with daytime, it is more difficult for patients to consciously suppress their
Management of sleep disorders in patients with AD
Currently, there is no consensus guiding the management of sleep disorders in patients with AD, and most treatment methods are based on expert opinion.69 Guidelines for AD have recommended that treatment of AD should focus on disease control, with sleep disturbance as one of the measures of control.70 Clinical trials that have assessed the effect of treatment on sleep in patients with AD are also mostly trials for disease-controlling agents, which evaluated sleep as a secondary outcome. Such
Conclusions
Sleep disorders are very common in patients with AD and have a wide range of effects. The relationship between sleep disorders and AD seems to be bidirectional and likely forms a vicious cycle. Instead of regarding sleep disorders as only one of the symptoms or disease severity measures for AD, we suggest viewing sleep disorders as a comorbidity of AD for which one should screen regularly, and specific treatments for sleep disorders should be incorporated into management strategies.
References (81)
- et al.
Deciphering the complexities of atopic dermatitis: shifting paradigms in treatment approaches
J Allergy Clin Immunol
(2014) - et al.
Eczema and sleep and its relationship to daytime functioning in children
Sleep Med Rev
(2010) - et al.
Effect of pimecrolimus cream 1% on skin condition and sleep disturbance in children with atopic dermatitis
J Allergy Clin Immunol
(2004) - et al.
Dupilumab therapy provides clinically meaningful improvement in patient-reported outcomes (PROs): a phase IIb, randomized, placebo-controlled, clinical trial in adult patients with moderate to severe atopic dermatitis (AD)
J Am Acad Dermatol
(2016) - et al.
Sleep-related disorders in Latin-American children with atopic dermatitis: a case control study
Allergol Immunopathol (Madr)
(2017) - et al.
Sleep disturbances in adults with eczema are associated with impaired overall health: a US population-based study
J Invest Dermatol
(2015) - et al.
The development of an objective method for measuring scratch in children with atopic dermatitis suitable for clinical use
J Am Acad Dermatol
(2004) - et al.
Obstructive sleep apnea and dermatologic disorders
Clin Dermatol
(2017) - et al.
Quantitative analysis of nerve growth factor (NGF) in the atopic dermatitis and psoriasis horny layer and effect of treatment on NGF in atopic dermatitis
J Dermatol Sci
(2009) Cytokines and sleep
Sleep Med Rev
(2005)
The immunology of atopic dermatitis and its reversibility with broad-spectrum and targeted therapies
J Allergy Clin Immunol
Cytokine modulation of atopic itch
Curr Opin Immunol
Disease severity, scratching, and sleep quality in patients with atopic dermatitis
J Am Acad Dermatol
Circadian and ultradian (12 h) variations of skin blood flow and barrier function in non-irritated and irritated skin-effect of topical corticosteroids
J Invest Dermatol
Linoleic acid metabolite levels and transepidermal water loss in children with atopic dermatitis
Ann Allergy Asthma Immunol
Sleep loss and inflammation
Best Pract Res Clin Endocrinol Metab
Nocturnal eczema: Review of sleep and circadian rhythms in children with atopic dermatitis and future research directions
J Allergy Clin Immunol
An assessment of the use of antihistamines in the management of atopic dermatitis
J Am Acad Dermatol
Management of sleep disturbance associated with atopic dermatitis
J Allergy Clin Immunol
Mindfulness meditation for insomnia: A meta-analysis of randomized controlled trials
J Psychosom Res
Atopic dermatitis
N Engl J Med
Atopic dermatitis: quality of life of young Italian children and their families and correlation with severity score
Pediatr Allergy Immunol
Quality of life and childhood atopic dermatitis: the misery of living with childhood eczema
Int J Clin Pract
Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis
Dermatology
Assessing itch in children with atopic dermatitis treated with tacrolimus: objective versus subjective assessment
Adv Ther
Sleep patterns in children with atopic eczema
Acta Derm Venereol
The price of pruritus: sleep disturbance and cosleeping in atopic dermatitis
Arch Pediatr Adolesc Med
Does age or gender influence quality of life in children with atopic dermatitis?
Clin Exp Dermatol
Sleep difficulties and their management in preschoolers with atopic eczema
Clin Exp Dermatol
Sleep patterns of young children with newly diagnosed atopic dermatitis
Postepy Dermatol Alergol
Atopic dermatitis, melatonin, and sleep disturbance
Pediatrics
Frequency and management of sleep disturbance in adults with atopic dermatitis: a systematic review
Dermatol Ther (Heidelb)
The Infants' Dermatitis Quality of Life Index
Br J Dermatol
Eczema, sleep, and behavior in children
J Clin Sleep Med
Sleep disturbances in children with atopic dermatitis
Arch Pediatr Adolesc Med
Sleep fragmentation in children with atopic dermatitis
Arch Pediatr Adolesc Med
Sleep and nighttime pruritus in children with atopic dermatitis
Sleep
Resting energy expenditure, oxygen consumption and carbon dioxide production during sleep in children with atopic dermatitis
J Dermatolog Treat
Physiological sleep disturbance in children with atopic dermatitis: a case control study
Pediatr Dermatol
Nocturnal wrist movements are correlated with objective clinical scores and plasma chemokine levels in children with atopic dermatitis
Br J Dermatol
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Disclosure of potential conflict of interest: The authors declare that they have no relevant conflicts of interest.