Reviews and feature article
Sleep disorders and atopic dermatitis: A 2-way street?

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Sleep disturbance is very common in patients with atopic dermatitis (AD) and is a major factor leading to impaired quality of life. Sleep disturbance is often viewed as one of the symptoms of AD and one of the measures of disease severity. In this review we describe a variety of sleep disorders associated with AD and a wide range of effect that sleep disorders have on patients with AD. We also discuss our current understanding of the mechanism of sleep disturbance in patients with AD. The relationship between sleep disorders and AD might be bidirectional and could form a vicious cycle. Therefore we suggest viewing sleep disorders as a comorbidity of AD for which regular screening and bidirectional management strategies are indicated, with equal focus on maintaining disease control and implementing specific strategies to improve sleep.

Section snippets

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.

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    Disclosure of potential conflict of interest: The authors declare that they have no relevant conflicts of interest.

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