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Yosipovitch G, Gooderham MJ, Ständer S, Fonacier L, Szepietowski JC, Deleuran M, Girolomoni G, Su JC, Bushmakin AG, Cappelleri JC, Feeney C, Chan G, Thorpe AJ, Valdez H, Biswas P, Rojo R, DiBonaventura M, Myers DE. Interpreting the Relationship Among Itch, Sleep, and Work Productivity in Patients with Moderate-to-Severe Atopic Dermatitis: A Post Hoc Analysis of JADE MONO-2. Am J Clin Dermatol 2024; 25:127-138. [PMID: 37624488 PMCID: PMC10796557 DOI: 10.1007/s40257-023-00810-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Abrocitinib, an oral, once-daily Janus kinase 1-selective inhibitor, improved itch severity, sleep, and work productivity versus placebo in patients with moderate-to-severe atopic dermatitis. OBJECTIVE The aim of this study was to investigate relationships among itch, sleep, and work productivity in the phase III JADE MONO-2 clinical trial. METHODS A repeated-measures longitudinal model was used to examine relationships between itch (using the Peak Pruritus Numerical Rating Scale [PP-NRS] or Nighttime Itch Scale [NTIS]) and sleep disturbance/loss (using the Patient-Oriented Eczema Measure sleep item and SCORing AD Sleep Loss Visual Analog Scale) and, separately, between itch and work productivity (using the Work Productivity and Activity Impairment-Atopic Dermatitis Version 2.0 questionnaire). Mediation modelling was used to investigate the effect of treatment (abrocitinib vs placebo) on work impairment via improvements in itch and sleep. RESULTS The relationships between itch/sleep and itch/work productivity were approximately linear. PP-NRS scores of 0, 4-6, and 10 were associated with 0 days, 3-4 days, and 7 days per week of disturbed sleep, respectively. PP-NRS or NTIS scores of 0-1, 4-5, and 10 were associated with 0-10%, 20-30%, and >50% overall work impairment, respectively. Seventy-five percent of the effect of abrocitinib on reducing work impairment was indirectly mediated by improvement in itch, followed by sleep. CONCLUSION These results quantitatively demonstrate that reducing itch severity is associated with improvements in sleep and work productivity. Empirical evidence for the mechanism of action of abrocitinib showed that itch severity is improved, which reduces sleep loss/sleep disruption and, in turn, improves work productivity. CLINICAL TRIAL REGISTRATION NCT03575871.
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Affiliation(s)
- Gil Yosipovitch
- Department of Dermatology, Miami Itch Center, Miami, FL, USA
| | | | - Sonja Ständer
- Department of Dermatology, Center for Chronic Pruritus, Münster University Hospital, Münster, Germany
| | - Luz Fonacier
- NYU Langone Hospital-Long Island Allergy and Immunology, Mineola, NY, USA
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Mette Deleuran
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | | | - John C Su
- Department of Paediatrics, Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Parkville, Australia
- Department of Dermatology, Monash University, Eastern Health, Box Hill, VIC, Australia
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Duan GY, Silverberg JI. Sleep impairment in patients with chronic inflammatory skin diseases: A review of mechanisms and management. J Am Acad Dermatol 2023; 88:421-427. [PMID: 35700930 DOI: 10.1016/j.jaad.2022.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/02/2022] [Accepted: 06/05/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Chronic inflammatory skin diseases (CISD), such as atopic dermatitis and psoriasis, are associated with nocturnal sleep disturbances, which may in turn exacerbate inflammation. OBJECTIVE To summarize the complex factors that underlie the relationship between CISD and sleep impairment. METHODS We conducted a focused review of the published literature, including retrospective, prospective, and interventional studies, clinical trials, reviews, and consensus guidelines. RESULTS The results of our literature review identified a complex interplay among various physiological, psychosocial, and behavioral factors mediating the relationship between sleep loss and CISD alongside targeted management strategies. We highlight treatment strategies that target these pathways, providing a practical framework for clinicians managing sleep loss in patients with CISD. Current guidelines by dermatology societies on the management of sleep disturbances in patients with CISD are limited and largely focus mostly on atopic dermatitis and psoriasis. CONCLUSIONS We recommend that sleep problems must be regularly assessed and managed in patients with CISD. Updated clinician guidelines are needed to better recognize and address the multifactorial nature of sleep loss in patients with CISD.
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Affiliation(s)
- Grace Y Duan
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
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Xu G, Tang W, Zhou C, Xu J, Cheng C, Gong W, Dong S, Zhang Y. Pain Fluctuations of Women with Subacute Herpetic Neuralgia During Local Methylcobalamin in Combination with Lidocaine Treatment: A Single-Blinded Randomized Controlled Trial. J Pain Res 2023; 16:1267-1284. [PMID: 37090764 PMCID: PMC10115195 DOI: 10.2147/jpr.s404713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/12/2023] [Indexed: 04/25/2023] Open
Abstract
Purpose To evaluate the efficacy and pain fluctuations of methylcobalamin in combination with lidocaine local injection treatment for subacute herpetic neuralgia (SHN). Methods Seventy-nine women (60.4 ± 2.7 years) with thoracic SHN were enrolled and randomized to receive a combination of methylcobalamin and lidocaine local injection (MI, N=40), or a combination of lidocaine patch 5% and oral methylcobalamin (PO, N=39) for four weeks. Repeated-measures analyses of variance were used to evaluate the effect on pain levels. Generalized estimation equations were used to analyze the cause-effect relationship between pain fluctuations and influencing factors. Results At the treatment endpoint, the group, treatment time, and group interacted with treatment time effects of the pain scores and area were statistically significant (P<0.001), The pain scores were 2.9 ±0.9 (MI) and 4.3 ± 1.5 (PO). 80.00% (MI) or 28.21% (PO) of patients had pain scores ≤ 3, the odds ratio was 2.84 (95% CI: 1.68 to 4.79). The incidence of postherpetic neuralgia was 5.0% (2/40) at 3 months. Pain fluctuated repeatedly during treatment. The pain fluctuation increased from 8.75 log folds in the afternoon, to 79.85 log folds at night. With the ADLs level increasing from 1 to 3, the pain fluctuated from 4.28 to 17.70 log folds. Allodynia, itching, sleep quality, and ADLs were the significant influencing factors (P<0.05). Conclusion This study validated the efficacy of methylcobalamin combined with lidocaine for SHN, and confirmed that pain levels in patients with SHN had an obvious circadian rhythm. ADLs were an important cause of pain fluctuations.
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Affiliation(s)
- Gang Xu
- Department of Rehabilitation Medicine, Affiliated Tenth People’s Hospital of Tongji University, Shanghai Tenth People’s Hospital, Shanghai, 200072, People’s Republic of China
- Correspondence: Gang Xu, Department of Rehabilitation Medicine, Affiliated Tenth People’s Hospital of Tongji University, Shanghai Tenth People’s Hospital, 301 Middle Yanchang Road, Shanghai, 200072, People’s Republic of China, Tel +8621-66306496, Fax +8621-66301051, Email
| | - Weizhen Tang
- Department of Rehabilitation Medicine, Affiliated Tenth People’s Hospital of Tongji University, Shanghai Tenth People’s Hospital, Shanghai, 200072, People’s Republic of China
| | - Chaosheng Zhou
- Department of Rehabilitation Medicine, Affiliated Tenth People’s Hospital of Tongji University, Shanghai Tenth People’s Hospital, Shanghai, 200072, People’s Republic of China
| | - Jie Xu
- Department of Rehabilitation Medicine, Affiliated Tenth People’s Hospital of Tongji University, Shanghai Tenth People’s Hospital, Shanghai, 200072, People’s Republic of China
| | - Chao Cheng
- Department of Rehabilitation Medicine, Affiliated Tenth People’s Hospital of Tongji University, Shanghai Tenth People’s Hospital, Shanghai, 200072, People’s Republic of China
| | - Weiwei Gong
- Department of Rehabilitation Medicine, Tongji University School of Medicine, Shanghai, 200092, People’s Republic of China
- Department of Rehabilitation Medicine, Shanghai First Rehabilitation Hospital, Shanghai, 200090, People’s Republic of China
| | - Shihong Dong
- Department of Rehabilitation Medicine, Tongji University School of Medicine, Shanghai, 200092, People’s Republic of China
| | - Yu Zhang
- Department of Rehabilitation Medicine, Affiliated Tenth People’s Hospital of Tongji University, Shanghai Tenth People’s Hospital, Shanghai, 200072, People’s Republic of China
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Chun KS, Kang YJ, Lee JY, Nguyen M, Lee B, Lee R, Jo HH, Allen E, Chen H, Kim J, Yu L, Ni X, Lee K, Jeong H, Lee J, Park Y, Chung HU, Li AW, Lio PA, Yang AF, Fishbein AB, Paller AS, Rogers JA, Xu S. A skin-conformable wireless sensor to objectively quantify symptoms of pruritus. SCIENCE ADVANCES 2021; 7:7/18/eabf9405. [PMID: 33931455 PMCID: PMC8087407 DOI: 10.1126/sciadv.abf9405] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/15/2021] [Indexed: 05/27/2023]
Abstract
Itch is a common clinical symptom and major driver of disease-related morbidity across a wide range of medical conditions. A substantial unmet need is for objective, accurate measurements of itch. In this article, we present a noninvasive technology to objectively quantify scratching behavior via a soft, flexible, and wireless sensor that captures the acousto-mechanic signatures of scratching from the dorsum of the hand. A machine learning algorithm validated on data collected from healthy subjects (n = 10) indicates excellent performance relative to smartwatch-based approaches. Clinical validation in a cohort of predominately pediatric patients (n = 11) with moderate to severe atopic dermatitis included 46 sleep-nights totaling 378.4 hours. The data indicate an accuracy of 99.0% (84.3% sensitivity, 99.3% specificity) against visual observation. This work suggests broad capabilities relevant to applications ranging from assessing the efficacy of drugs for conditions that cause itch to monitoring disease severity and treatment response.
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Affiliation(s)
- Keum San Chun
- Electrical and Computer Engineering, The University of Texas at Austin, Austin, TX 78712, USA
| | - Youn J Kang
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
| | - Jong Yoon Lee
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Sibel Health, Niles, IL 60714, USA
| | - Morgan Nguyen
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Brad Lee
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | | | | | - Emily Allen
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Hope Chen
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
| | | | - Lian Yu
- Electrical and Computer Engineering, University of Illinois at Champaign-Urbana, Champaign, IL 61801, USA
| | - Xiaoyue Ni
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC 27708, USA
| | - KunHyuck Lee
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
| | - Hyoyoung Jeong
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
| | | | - Yoonseok Park
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
| | - Ha Uk Chung
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Sibel Health, Niles, IL 60714, USA
| | - Alvin W Li
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Peter A Lio
- Chicago Eczema Center, Chicago, IL 60654, USA
| | - Albert F Yang
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Anna B Fishbein
- Department of Pediatrics (Allergy and Immunology), Ann & Robert H. Lurie Children's Hospital, Chicago, IL 60611, USA
| | - Amy S Paller
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Department of Pediatrics (Dermatology), Ann & Robert H. Lurie Children's Hospital, Chicago, IL 60611, USA
| | - John A Rogers
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA.
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Shuai Xu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA.
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Department of Pediatrics (Allergy and Immunology), Ann & Robert H. Lurie Children's Hospital, Chicago, IL 60611, USA
- Department of Pediatrics (Dermatology), Ann & Robert H. Lurie Children's Hospital, Chicago, IL 60611, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
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Gupta MA, Gupta AK. Sleep/wake detection by behavioral response to haptic stimuli may be confounded by the sleep stage during which the haptic stimuli are delivered. J Clin Sleep Med 2020; 16:823. [PMID: 32048594 DOI: 10.5664/jcsm.8364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Madhulika A Gupta
- Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Aditya K Gupta
- Department of Medicine, University of Toronto Medical School, University of Toronto, Toronto, Ontario, Canada
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Heckman CJ, Riley M, Valdes-Rodriguez R, Yosipovitch G. Development and Initial Psychometric Properties of Two Itch-Related Measures: Scratch Intensity and Impact, Sleep-Related Itch and Scratch. J Invest Dermatol 2020; 140:2138-2145.e1. [PMID: 32298670 DOI: 10.1016/j.jid.2020.03.961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/23/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
Abstract
Self-report measures are needed to better understand the relationships among sleep, itching, scratching, and chronic itch conditions and their associations with disease severity, QOL, health, and functioning. Two scales related to sleep and/or scratch were recently developed and assessed in 137 patients with chronic itch and atopic dermatitis or psoriasis. The Scratch Intensity and Impact Scale consisted of two factors (scratching intensity and impact of scratching on QOL) that accounted for 64.59% of the variance with a total of 13 items, overall Cronbach's α of 0.93, and test-retest reliability of 0.66. The Sleep-Related Itch and Scratch Scale consisted of one factor that accounted for 63.01% of the variance with a total of 16 items, overall Cronbach's α of 0.98, and test-retest reliability of 0.66. Both measures demonstrated significant correlations with each other as well as other itch-related measures and nonsignificant correlations with scales hypothesized to be unrelated. The final measures demonstrated adequate preliminary psychometric characteristics. It is hoped that these scales will be used for future research and clinical purposes to help fill recognized gaps in understanding about sleep, itch, scratching, atopic dermatitis, and psoriasis.
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Affiliation(s)
- Carolyn J Heckman
- Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
| | - Mary Riley
- Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | | | - Gil Yosipovitch
- Department of Dermatology, University of Miami, Miami, Florida, USA
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Ramirez FD, Chen S, Langan SM, Prather AA, McCulloch CE, Kidd SA, Cabana MD, Chren MM, Abuabara K. Assessment of Sleep Disturbances and Exhaustion in Mothers of Children With Atopic Dermatitis. JAMA Dermatol 2019; 155:556-563. [PMID: 30892577 PMCID: PMC6506883 DOI: 10.1001/jamadermatol.2018.5641] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance The well-being and development of children is strongly influenced by parents' physical and psychosocial health. Data from small, clinic-based studies suggest that sleep loss may be common in parents of children with atopic dermatitis (AD), but longitudinal population-based studies are lacking. Objectives To compare sleep disturbances over time between mothers of children with and without AD and to determine whether these disturbances are associated with the child's disease severity and the child's sleep disturbances. Design, Setting, and Participants In the ongoing Avon Longitudinal Study of Parents and Children, all pregnant women residing in Avon, United Kingdom, with an expected delivery date between April 1, 1991, and December 31, 1992, were recruited. Analyses for this study, a secondary analysis of this cohort, were performed from September 2017 to September 2018. Mother-child pairs were followed up with a time-varying measure of child AD activity and severity and self-reported maternal sleep measures repeated at multiple time points between child ages 6 months and 11 years. Main Outcomes and Measures Time-varying binary measures of maternal sleep duration (<6 vs ≥6 hours per night), difficulty falling asleep, early morning awakening, subjectively insufficient sleep, and daytime exhaustion. Results The study followed up 13 988 mother-child pairs from birth for a median duration of 11 (interquartile range, 7-11) years. Among the cohort, 11 585 of 13 972 mothers (82.9%) were aged 21 to 34 years and 12 001 of 12 324 (97.4%) were of white race/ethnicity; 7220 of 13 978 children (51.7%) were male. Sleep duration (adjusted odds ratio [AOR], 1.09; 95% CI, 0.90-1.32) and early morning awakenings (AOR, 1.16; 95% CI, 0.93-1.46) were similar between mothers of children with and without AD. In contrast, mothers of children with AD were more likely to report difficulty falling asleep (AOR, 1.36; 95% CI, 1.01-1.83), subjectively insufficient sleep (AOR, 1.43; 95% CI, 1.24-1.66), and daytime exhaustion (AOR, 1.41; 95% CI, 1.12-1.78) independent of the child's comorbid asthma and/or allergic rhinitis. For all measures, worse child AD severity was associated with worse maternal sleep outcomes. The magnitude and significance of the associations were largely unchanged after adjustment for child sleep disturbances. Conclusions and Relevance Mothers of children with AD reported difficulty falling asleep, subjectively insufficient sleep, and daytime exhaustion throughout the first 11 years of childhood. However, child sleep disturbances did not fully explain maternal sleep disturbances, and future research should investigate other mechanisms. In caring for children with AD, clinicians should consider maternal sleep disturbances and caregiver fatigue.
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Affiliation(s)
- Faustine D Ramirez
- Medical student, Department of Dermatology Program for Clinical Research, University of California, San Francisco
| | - Shelley Chen
- Medical student, Department of Dermatology Program for Clinical Research, University of California, San Francisco
| | - Sinéad M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Aric A Prather
- Department of Psychiatry, University of California, San Francisco
| | - Charles E McCulloch
- Department of Dermatology Program for Clinical Research, University of California, San Francisco
| | - Sharon A Kidd
- Department of Dermatology Program for Clinical Research, University of California, San Francisco
| | - Michael D Cabana
- Department of Epidemiology & Biostatistics, University of California, San Francisco.,Department of Pediatrics, University of California, San Francisco.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Mary-Margaret Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Katrina Abuabara
- Department of Dermatology Program for Clinical Research, University of California, San Francisco
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Ramirez FD, Chen S, Langan SM, Prather AA, McCulloch CE, Kidd SA, Cabana MD, Chren MM, Abuabara K. Association of Atopic Dermatitis With Sleep Quality in Children. JAMA Pediatr 2019; 173:e190025. [PMID: 30830151 PMCID: PMC6503516 DOI: 10.1001/jamapediatrics.2019.0025] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Pruritus, a hallmark of atopic dermatitis (AD), is thought to disrupt sleep, yet little is known about how variations in disease activity and severity of this common childhood condition may be associated with sleep patterns over time. Objective To determine whether children with active AD have impaired sleep duration and quality at multiple time points throughout childhood and whether disease severity affects sleep outcomes. Design, Setting, and Participants This longitudinal cohort study used data of children enrolled in the Avon Longitudinal Study of Parents and Children, a population-based birth cohort in Avon, United Kingdom. Participants were children (N = 13 988) alive at 1 year and followed up with repeated measures of self-reported AD and sleep through 16 years of age. This study was based on data collected from 1990 to 2008. Data analysis was performed from September 2017 to September 2018. Main Outcomes and Measures Standardized measure of sleep duration and composite measure of sleep quality, including nighttime awakenings, early morning awakenings, difficulty falling asleep, and nightmares, were repeated at multiple time points between 2 and 16 years of age. Results The study sample comprised 13 988 children (7220 male [51.6%]) followed up for a median (interquartile range [IQR]) duration of 11 (5-14) years. Of this total, 4938 children (35.3%) met the definition of having atopic dermatitis between 2 and 16 years of age. Total sleep duration was similar between children with active AD and without AD at all ages, and the average estimated difference across childhood was a clinically negligible difference of 2 minutes less per day for children with AD (95% CI, -4 to 0 minutes). In contrast, children with active AD were more likely to report worse sleep quality at all time points, with a nearly 50% higher odds of experiencing more sleep-quality disturbances (adjusted odds ratio [aOR], 1.48; 95% CI, 1.33 to 1.66). Children with more severe active disease (quite bad or very bad AD: aOR, 1.68; 95% CI, 1.42 to 1.98) and with comorbid asthma or allergic rhinitis (aOR, 1.79; 95% CI, 1.54 to 2.09) had worse sleep quality. However, even children with mild AD (OR, 1.40; 95% CI, 1.27 to 1.54) or inactive AD (OR, 1.41; 95% CI, 1.28 to 1.55) had statistically significantly increased odds of impaired sleep quality. Conclusions and Relevance Atopic dermatitis appeared to be associated with impaired sleep quality throughout childhood; thus, it is suggested that clinicians should consider sleep quality among all children with AD, especially those with comorbid asthma or allergic rhinitis and severe disease, and that interventions to improve sleep quality are needed.
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Affiliation(s)
- Faustine D Ramirez
- Department of Dermatology Program for Clinical Research, University of California, San Francisco, San Francisco
| | - Shelley Chen
- Department of Dermatology Program for Clinical Research, University of California, San Francisco, San Francisco
| | - Sinéad M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Aric A Prather
- Department of Psychiatry, University of California, San Francisco, San Francisco
| | - Charles E McCulloch
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco
| | - Sharon A Kidd
- Department of Dermatology Program for Clinical Research, University of California, San Francisco, San Francisco
| | - Michael D Cabana
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco.,Department of Pediatrics, University of California, San Francisco, San Francisco.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco
| | - Mary-Margaret Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Katrina Abuabara
- Department of Dermatology Program for Clinical Research, University of California, San Francisco, San Francisco
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Boozalis E, Grossberg AL, Püttgen KB, Cohen BA, Kwatra SG. Itching at night: A review on reducing nocturnal pruritus in children. Pediatr Dermatol 2018; 35:560-565. [PMID: 29943835 DOI: 10.1111/pde.13562] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The most common causes of chronic nocturnal itching in children are atopic dermatitis and psoriasis, with lichen simplex chronicus and prurigo nodularis contributing to lesser degrees. Despite the prevalence of nocturnal itching, its pathophysiology remains poorly understood. The most troubling consequence of itching at night is poor quality of sleep. Poor sleep quality in children with nocturnal itching has been linked to adverse neurocognitive, behavioral, and physiologic outcomes, including poor performance in school, attention deficit hyperactivity disorder, short stature, hypertension, obesity, and impaired immune function. There is no consensus on the best management of nocturnal itching in children. We conducted a review of the literature evaluating the efficacy of various treatment options for children with chronic nocturnal pruritus. Our review found three recently conducted randomized controlled trials and one case report demonstrating the efficacy of topical corticosteroids, oral melatonin, and clonidine in reducing nocturnal itching or improving sleep quality in children with nocturnal pruritus. Future research is needed to elucidate the pathophysiology of nocturnal itching to best develop targeted, effective treatment strategies.
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Affiliation(s)
- Emily Boozalis
- Department of Dermatology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Anna L Grossberg
- Department of Dermatology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Katherine B Püttgen
- Department of Dermatology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Bernard A Cohen
- Department of Dermatology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Shawn G Kwatra
- Department of Dermatology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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10
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Kogure T, Ebata T. Activity During Sleep Measured by a Sheet-Shaped Body Vibrometer and the Severity of Atopic Dermatitis in Adults: A Comparison With Wrist Actigraphy. J Clin Sleep Med 2018; 14:199-204. [PMID: 29351828 DOI: 10.5664/jcsm.6932] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/16/2017] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To use a sheet-shaped body vibrometer (SBV) for measuring sleep in adult patients with atopic dermatitis (AD) of various severities and to compare the results with those measured by wrist actigraphy (WA). METHODS Simultaneous measurements of activity during sleep by WA and the SBV were performed in 20 outpatients with AD for 5 to 10 days. The mean activity count per minute (ACT) and sleep efficiency (SE) were obtained using each device. The severity of AD was evaluated by the severity scoring of AD (SCORAD), serum thymus and activation-regulated chemokine (TARC) level, serum total immunoglobulin E level, and peripheral eosinophil count. RESULTS The ACT measured by WA was correlated with SCORAD (Spearman correlation coefficient [rs] = .64, P = .002) and TARC (rs = .60, P = .005). The ACT obtained by the SBV was significantly correlated with TARC (rs = .58, P = .008) and ACT obtained by WA (rs = .63, P = .003). SE obtained by WA resulted in lower values compared with SE obtained by the SBV (69.7 ± 9.4% versus 82.9 ± 9.3%, P < .001), although SE obtained by WA was highly correlated with SE obtained by the SBV (rs = .82, P < .001). Bland-Altman plots revealed that SE measured by WA always had lower values in all the patients. CONCLUSIONS Activity during sleep, presumably composed of scratching and other motions, is more vigorous in patients with severe adult AD. This was successfully demonstrated by the SBV and WA assessment. However, we consider that ACT measured by WA is more suited for the scratch evaluation and SE measured by the SBV is preferable for the sleep evaluation.
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Affiliation(s)
- Takamasa Kogure
- Department of Somnology, Tokyo Medical University, Tokyo, Japan.,Paramount Bed Sleep Research Laboratory, PARAMOUNT BED CO., LTD., Tokyo, Japan
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Fishbein AB, Mueller K, Kruse L, Boor P, Sheldon S, Zee P, Paller AS. Sleep disturbance in children with moderate/severe atopic dermatitis: A case-control study. J Am Acad Dermatol 2017; 78:336-341. [PMID: 29089179 DOI: 10.1016/j.jaad.2017.08.043] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 08/22/2017] [Accepted: 08/25/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Sleep is disturbed in 60% of children with atopic dermatitis (AD). OBJECTIVE To characterize sleep in a cohort of children with moderate-to-severe AD and determine methods for assessment of sleep disturbance. METHODS A case-control study compared children age 6 to 17 years who have moderate-to-severe AD with age- and sex-matched healthy controls. Participants wore actigraphy watches and completed sleep- and disease-specific questionnaires. RESULTS Nineteen patients with AD and 19 controls completed the study. The patients with AD experienced wake after sleep onset (WASO) for 103 plus or minus 55 minutes as compared with 50 plus or minus 27 minutes in the controls (P < .01). They had a higher frequency of restless sleep, daytime sleepiness, difficulty falling back to sleep at night, and teacher-reported daytime sleepiness. Disease severity correlated well with WASO (total SCORing Atopic Dermatitis score: r = 0.61, P < .01; objective SCORing Atopic Dermatitis score: r = 0.58, P = .01; and Eczema Area and Severity Index: r = 0.68, P < .01). The Children's Dermatology Life Quality Index sleep question correlated with WASO (r = 0.52, P = .03), but self-reported itch severity did not (r = 0.28, P = .30). LIMITATIONS The study cohort was small. CONCLUSION Children with moderate-to-severe AD experience more WASO and lower sleep efficiency than healthy controls but similar bedtime and wake time, sleep duration, and sleep onset latency.
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Affiliation(s)
- Anna B Fishbein
- Division of Allergy & Immunology, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois.
| | - Kelly Mueller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lacey Kruse
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Peter Boor
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Stephen Sheldon
- Division of Pulmonology, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Phyllis Zee
- Center for Circadian and Sleep Medicine, Northwestern University, Chicago, Illinois
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Ricketts EJ, Snorrason I, Rozenman M, Colwell CS, McCracken JT, Piacentini J. Sleep functioning in adults with trichotillomania (hair-pulling disorder), excoriation (skin-picking) disorder, and a non-affected comparison sample. J Obsessive Compuls Relat Disord 2017; 13:49-57. [PMID: 32467821 PMCID: PMC7255435 DOI: 10.1016/j.jocrd.2017.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The present study assessed sleep functioning in Trichotillomania (TTM; Hair-Pulling Disorder) and Excoriation (Skin-Picking) Disorder (ExD), and a non-affected comparison group, and examined the prevalence and correlates of bedtime and sleep-related hair pulling and skin picking. Participants were adult internet survey respondents, who met diagnostic criteria for TTM (N=259), ExD (N=182), or did not meet criteria for these disorders (N=148). Individuals with TTM and ExD endorsed significantly greater sleep disturbance relative to the comparison group, even after controlling for internalizing (anxiety and depression) symptoms. Hair pulling and skin picking severity were not significantly correlated with sleep disturbance after controlling for internalizing symptoms. Pulling and picking during sleep occurred at rates of 13% and 27%, respectively. Picking severity, anxiety and depressive symptoms, and sleep disturbance were significantly increased in those who engaged in picking during sleep relative to those who did not endorse this behavior. No significant differences were found between those endorsing pulling during sleep and those not endorsing this on demographic, clinical, or sleep variables. The present study highlights the potential role of sleep disturbance in TTM and ExD, and the need for further research in this area.
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Affiliation(s)
- Emily J. Ricketts
- University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, United States
| | - Ivar Snorrason
- University of Wisconsin-Milwaukee, Department of Psychology, United States
| | - Michelle Rozenman
- University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, United States
| | - Christopher S. Colwell
- University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, United States
| | - James T. McCracken
- University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, United States
| | - John Piacentini
- University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, United States
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Nocturnal Pruritus: The Battle for a Peaceful Night's Sleep. Int J Mol Sci 2016; 17:425. [PMID: 27011178 PMCID: PMC4813276 DOI: 10.3390/ijms17030425] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 03/16/2016] [Accepted: 03/16/2016] [Indexed: 12/26/2022] Open
Abstract
Chronic pruritus is a debilitating condition with numerous etiologies. Many patients suffer from nocturnal pruritus, which can decrease quality of life and affect mortality in hemodialysis patients. Nocturnal pruritus may occur in all sleep stages but is most prevalent in stages N1 and N2. Further research is needed to elucidate the pathophysiology of nocturnal itch, which will aid in the development of tailored management strategies.
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Fishbein AB, Vitaterna O, Haugh IM, Bavishi AA, Zee PC, Turek FW, Sheldon SH, Silverberg JI, Paller AS. Nocturnal eczema: Review of sleep and circadian rhythms in children with atopic dermatitis and future research directions. J Allergy Clin Immunol 2015; 136:1170-7. [DOI: 10.1016/j.jaci.2015.08.028] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 08/07/2015] [Accepted: 08/11/2015] [Indexed: 01/25/2023]
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Petersen J, Austin D, Sack R, Hayes TL. Actigraphy-Based Scratch Detection Using Logistic Regression. IEEE J Biomed Health Inform 2013; 17:277-83. [DOI: 10.1109/titb.2012.2204761] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Feuerstein J, Austin D, Sack R, Hayes TL. Wrist actigraphy for scratch detection in the presence of confounding activities. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2012; 2011:3652-5. [PMID: 22255131 DOI: 10.1109/iembs.2011.6090615] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Scratching is a symptom of many dermatological disorders, especially atopic dermatitis. For the development of anti-itch medications, there is a need for objective measures of scratching. Wrist actigraphy (monitoring wrist and hand movements with micro-accelerometers) is a promising method for assessing scratching; however, currently available technology has a limited capacity to discriminate scratching from other similar movements. In this study, we investigated methods to improve the specificity of actigraphy for scratch detection on movement data collected from subjects using the PAM-RL actigraph. A k-means cluster analysis was used to differentiate scratching from walking and restless sleep, which are potential confounds for nighttime scratching. Features used in the analysis include variance, peak frequency, autocorrelation value at one lag, and number of counts above 0.01 g's. The k-means cluster analysis exhibited a high sensitivity (0.90 ± 0.10) and specificity for walking (0.98 ± 0.05) and restless sleep (0.88 ± 0.06), respectively, demonstrating the separability of these activities. This work indicates that the features described here can be used to develop a classifier that discriminates scratch from other activities. The described method of scratch detection shows promise as an objective method for assessing scratching movements in clinical trials and longitudinal studies of scratch.
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Affiliation(s)
- Johanna Feuerstein
- Department of Biomedical Engineering, Oregon Health & Science University, 3303 SW Bond Avenue, Portland, OR 97239, USA.
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