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Silva PL, Ramos T, Castro NP, Richetto N, López RV, Luzia LA, Rondó PH. Factors Related to the Sleep Duration of 3-Month-Old Infants. Sleep Sci 2024; 17:e281-e288. [PMID: 39268339 PMCID: PMC11390173 DOI: 10.1055/s-0044-1782168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/05/2023] [Indexed: 09/15/2024] Open
Abstract
Objective To identify the factors related to sleep duration in 3-month-old infants. Materials and Methods From 2021 to 2023, we conducted a cross-sectional study in the city of Araraquara, Brazil, involving 140 mothers and their respective 3-month-old infants. Maternal socioeconomic, demographic, obstetric, and nutritional characteristics, as well as nutritional and morbidity characteristics of the respective infants, were evaluated. Sleep duration was determined by the Brief Infant Sleep Questionnaire (BISQ). Multivariate linear regression analysis was used to assess the associations of maternal, newborn, and infant factors with sleep duration at three months. Results The nighttime sleep duration of the infants was of 9 hours. There were negative associations between nighttime sleep duration and prone sleep position ( p = 0.011), falling asleep between 8:30 pm and 11:00 pm ( p = 0.032), falling asleep after 11:00 pm ( p < 0.001), respiratory infection ( p = 0.011), dermatitis ( p = 0.002), and the presence of children under 9 years of age in the household ( p = 0.013). Discussion In the present study, factors such as infant morbidity, the presence of other children in the household, and sleeping habits were associated with a decrease in sleep duration in 3-month-old infants. Therefore, we emphasize the importance of early diagnosis of morbidity in the first months of life and of promoting healthy habits such as regulating the time to go to sleep, providing an adequate sleep environment, and other practices that help improve the quality and duration of sleep.
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Affiliation(s)
- Paula Louro Silva
- Department of Nutrition, School of Public Health, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Tamiris Ramos
- Department of Nutrition, School of Public Health, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Natalia Pinheiro Castro
- Department of Nutrition, School of Public Health, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Nicole Richetto
- Department of Nutrition, School of Public Health, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Rossana Verônica López
- Oncology Translational Research Center, Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil
| | - Liania Alves Luzia
- Department of Nutrition, School of Public Health, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Patricia Helen Rondó
- Department of Nutrition, School of Public Health, Universidade de São Paulo, São Paulo, SP, Brazil
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Wong QYA, Lim JJ, Ng JY, Lim YYE, Sio YY, Chew FT. Sleep and allergic diseases among young Chinese adults from the Singapore/Malaysia Cross-Sectional Genetic Epidemiology Study (SMCGES) cohort. J Physiol Anthropol 2024; 43:6. [PMID: 38291494 PMCID: PMC10826209 DOI: 10.1186/s40101-024-00356-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 01/19/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Sleep disruption has been shown to affect immune function and thus influence allergic disease manifestation. The specific effects of sleep on allergic diseases, however, are less well-established; hence, in a unique population of young Chinese adults, we investigated the association between sleep and allergic disease. METHODS Young Chinese adults recruited from Singapore in the Singapore/Malaysia Cross-Sectional Genetic Epidemiology Study (SMCGES) were analyzed. We used the International Study of Asthma and Allergies in Childhood (ISAAC) protocol and a skin prick test to determine atopic dermatitis (AD), allergic rhinitis (AR), and asthma status. Information regarding total sleep time (TST) and sleep quality (SQ) was also obtained. RESULTS Of 1558 participants with a mean age of 25.0 years (SD = 7.6), 61.4% were female, and the mean total sleep time (TST) was 6.8 h (SD = 1.1). The proportions of AD, AR, and asthma were 24.5% (393/1542), 36.4% (987/1551), and 14.7% (227/1547), respectively. 59.8% (235/393) of AD cases suffered from AD-related sleep disturbances, 37.1% (209/564) of AR cases suffered from AR-related sleep disturbances, and 25.1% (57/227) of asthma cases suffered from asthma-related sleep disturbances. Only asthma cases showed a significantly lower mean TST than those without asthma (p = 0.015). Longer TST was significantly associated with lower odds of AR (OR = 0.905, 95% CI = 0.820-0.999) and asthma (OR = 0.852, 95% CI = 0.746-0.972). Linear regression analyses showed that lower TST was significantly associated with asthma (β = - 0.18, SE = 0.076, p-value = 0.017), and AR when adjusted for AR-related sleep disturbances (β = - 0.157, SE = 0.065, p-value = 0.016). Only sleep disturbances due to AR were significantly associated with a poorer SQ (OR = 1.962, 95% CI = 1.245-3.089). CONCLUSIONS We found that sleep quality, but not sleep duration was significantly poorer among AD cases, although the exact direction of influence could not be determined. In consideration of the literature coupled with our findings, we posit that TST influences allergic rhinitis rather than vice versa. Finally, the association between TST and asthma is likely mediated by asthma-related sleep disturbances, since mean TST was significantly lower among those with nighttime asthma symptoms. Future studies could consider using objective sleep measurements coupled with differential expression analysis to investigate the pathophysiology of sleep and allergic diseases.
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Affiliation(s)
- Qi Yi Ambrose Wong
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Allergy and Molecular Immunology Laboratory, Lee Hiok Kwee Functional Genomics Laboratories, Block S2, Level 5, 14 Science Drive 4, Lower Kent Ridge Road, Singapore, 117543, Singapore
| | - Jun Jie Lim
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Allergy and Molecular Immunology Laboratory, Lee Hiok Kwee Functional Genomics Laboratories, Block S2, Level 5, 14 Science Drive 4, Lower Kent Ridge Road, Singapore, 117543, Singapore
| | - Jun Yan Ng
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Allergy and Molecular Immunology Laboratory, Lee Hiok Kwee Functional Genomics Laboratories, Block S2, Level 5, 14 Science Drive 4, Lower Kent Ridge Road, Singapore, 117543, Singapore
| | - Yi Ying Eliza Lim
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Allergy and Molecular Immunology Laboratory, Lee Hiok Kwee Functional Genomics Laboratories, Block S2, Level 5, 14 Science Drive 4, Lower Kent Ridge Road, Singapore, 117543, Singapore
| | - Yang Yie Sio
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Allergy and Molecular Immunology Laboratory, Lee Hiok Kwee Functional Genomics Laboratories, Block S2, Level 5, 14 Science Drive 4, Lower Kent Ridge Road, Singapore, 117543, Singapore
| | - Fook Tim Chew
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Allergy and Molecular Immunology Laboratory, Lee Hiok Kwee Functional Genomics Laboratories, Block S2, Level 5, 14 Science Drive 4, Lower Kent Ridge Road, Singapore, 117543, Singapore.
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Lee DG, Gui XY, Mukovozov I, Fleming P, Lynde C. Sleep Disturbances in Children With Atopic Dermatitis: A Scoping Review. J Cutan Med Surg 2023; 27:157-164. [PMID: 36880965 PMCID: PMC10068401 DOI: 10.1177/12034754231159337] [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] [Indexed: 03/08/2023]
Abstract
Atopic dermatitis (AD) is associated with various quality of life concerns including poor sleep. Sleep impairments in children with AD are associated with increased risk of short stature, metabolic syndrome, mental illness and neurocognitive dysfunction. Although the association between AD and sleep disturbance is well established, the specific types of sleep disturbance in pediatric AD patients and their underlying mechanisms are not fully understood. A scoping literature review was performed to characterize and summarize the types of sleep disturbance in children (less than 18 years of age) with AD. 31 papers met inclusion criteria and extracted data were analyzed in an iterative manner. Two types of sleep disturbances were found to be more prevalent in pediatric AD patients in comparison to controls. One category was related to loss of sleep (increased frequency or duration of awakenings, increased sleep fragmentation, delayed sleep onset, decreased total sleep duration, and decreased sleep efficiency). Another category was associated with unusual behaviors during sleep (restlessness/limb movement/scratching, sleep-disordered breathing including obstructive sleep apnea and snoring, nightmares, nocturnal enuresis and nocturnal hyperhidrosis). Some mechanisms underlying these sleep disturbances include pruritus and induced scratching and increased proinflammatory markers induced by sleep loss. Sleep disturbance appears to be associated with AD. We recommend clinicians to consider interventions that may reduce sleep disturbances in children with AD. Further investigation of these sleep disturbances is needed to elucidate pathophysiology, develop additional treatments, and reduce negative impacts on the health outcomes and quality of life in pediatric AD patients.
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Affiliation(s)
- Dong Goo Lee
- 12358 Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Xi Yao Gui
- 12358 Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ilya Mukovozov
- 12358 Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,12358 Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Patrick Fleming
- 12366 Division of Dermatology, University of Toronto, Toronto, ON, Canada
| | - Charles Lynde
- 12366 Division of Dermatology, University of Toronto, Toronto, ON, Canada.,The Lynde Institute for Dermatology, Markham, ON, Canada
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Dwiyana RF, Nuraeni L, Diana IA, Effendi RMRA, Gondokaryono SP, Ruchiatan K, Hindritiani R, Gunawan H. Melatonin and Sleep Disturbances in Children With Atopic Dermatitis. Clin Cosmet Investig Dermatol 2022; 15:1175-1182. [PMID: 35784269 PMCID: PMC9249347 DOI: 10.2147/ccid.s366854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/01/2022] [Indexed: 11/23/2022]
Abstract
Objective To evaluate the correlation between melatonin levels and sleep quality, based on the Children’s Sleep Habit Questionnaire (CSHQ), among children with atopic dermatitis (AD). Methods This was an analytic study with a cross-sectional design involving two groups, AD children as the case group and participants without AD as the control group, conducted at the Pediatric Dermatology Clinic of Dr. Hasan Sadikin Hospital, Bandung, Indonesia. Melatonin levels and CSHQ score in the case group were compared to that in the control group. Correlation analysis was performed between melatonin levels and sleep quality based on CSHQ in the case group. Results Participants in this study consisted of 19 children with moderate AD, (no patient with mild and severe AD was recruited), and 19 participants without AD. The mean CSHQ score in the case group was significantly higher than the control group (47.84 vs 36.79; p<0.05). The mean melatonin level in the case group was significantly lower than the control group (320.18 pg/mL vs 383.86 pg/mL; p<0.05). Comparative analysis was conducted using independent t-test. There was a significant Pearson’s correlation index between SCORAD and CSHQ (p<0.05). However, there was no correlation between melatonin levels and CSHQ, as well as between melatonin levels and SCORAD (p<0.05). Conclusion Children with moderate AD have impaired sleep quality and lower melatonin levels compared to controls. No correlation was found between melatonin levels and CSHQ, as well as melatonin levels and SCORAD, although there was a strong and significant correlation between SCORAD and CSHQ. Therefore, melatonin levels may not be the main cause of sleep disturbances in children with moderate AD.
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Affiliation(s)
- Reiva Farah Dwiyana
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Lita Nuraeni
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Inne Arline Diana
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Raden Mohamad Rendy Ariezal Effendi
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Srie Prihianti Gondokaryono
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Kartika Ruchiatan
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Reti Hindritiani
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Hendra Gunawan
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
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Zhou NY, Nili A, Blackwell CK, Ogbuefi N, Cummings P, Lai JS, Griffith JW, Paller AS, Wakschlag LS, Fishbein AB. Parent report of sleep health and attention regulation in a cross-sectional study of infants and preschool-aged children with atopic dermatitis. Pediatr Dermatol 2022; 39:61-68. [PMID: 34935180 PMCID: PMC9308997 DOI: 10.1111/pde.14889] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES Older children with atopic dermatitis (AD) suffer from poor sleep and attention problems. However, until recently, the dearth of developmentally sensitive assessment tools impeded characterization in younger children. We aimed to characterize sleep and attention problems in young children with AD and identify modifiable factors. METHODS A cross-sectional study of children with AD aged 1-4 years was stratified by disease severity (Patient-Oriented Eczema Measure), age, and racial/ethnic groups. Developmentally sensitive surveys assessed attention (Multidimensional Assessment Profile of Attention Regulation), sleep, and itch (Patient-Reported Outcomes Measurement Information System). Linear regression models identified predictors of sleep health and attention dysregulation. RESULTS Parents (n = 60) of children aged 2.78 ± 0.98 years with severe (n = 25), moderate (n = 25), or mild (n = 10) AD were recruited across the United States. Significantly reduced sleep health (T-score ≥ 60) was reported in 86% of children with moderate/severe disease (n = 43), and 50% had ≥5 nights of disturbed sleep per week. A suboptimal sleep environment was identified with 32% of children with too much light, noise, or electronic device usage. With regard to attention regulation, in children with severe AD, 80% had trouble sitting still and 72% of children had trouble paying attention no matter their surroundings. In fully adjusted models, AD severity was a significant predictor of poor sleep health (B = 0.79 [0.31-1.28], p < .01) and attention dysregulation (B = 1.22 [0.51-1.93], p < .01). CONCLUSIONS More severe AD correlates with poor sleep health and attention dysregulation. In addition to aggressive treatment of AD, clinicians should advise on modifiable sleep hygiene practices and consider screening for attention dysregulation in young children.
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Affiliation(s)
- Nina Y Zhou
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Amanda Nili
- Department of Medical Social Sciences and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, Illinois, USA
| | - Courtney K Blackwell
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nonye Ogbuefi
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Peter Cummings
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jin-Shei Lai
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, Illinois, USA
| | - James W Griffith
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amy S Paller
- Department of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lauren S Wakschlag
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, Illinois, USA.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anna B Fishbein
- Division of Pediatric Allergy & Immunology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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6
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Jaworek AK, Szepietowski JC, Hałubiec P, Wojas-Pelc A, Jaworek J. Melatonin as an Antioxidant and Immunomodulator in Atopic Dermatitis-A New Look on an Old Story: A Review. Antioxidants (Basel) 2021; 10:antiox10081179. [PMID: 34439427 PMCID: PMC8388892 DOI: 10.3390/antiox10081179] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/16/2021] [Accepted: 07/22/2021] [Indexed: 12/15/2022] Open
Abstract
Atopic dermatitis (AD) is common inflammatory dermatosis, typically with chronic and recurrent course, which significantly reduces the quality of life. Sleep disturbances are considered to be remarkably burdensome ailments in patients with AD, and are routinely included during assessment of disease severity. Therefore, endogenous substances engaged in the control of circadian rhythms might be important in pathogenesis of AD and, possibly, be used as biomarkers of disease severity or even in development of novel therapies. Melatonin (MT), the indoleamine produced by pineal gland (but also by multiple other tissues, including skin), plays a pivotal role in maintaining the sleep/wake homeostasis. Additionally, it possesses strong antioxidant and anti-inflammatory properties, which might directly link chronic skin inflammation and sleep abnormalities characteristic of AD. The objective of this work is to systematically present and summarize the results of studies (both experimental and clinical) that investigated the role of MT in the AD, with a focus on the antioxidant and immunomodulatory effects of MT.
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Affiliation(s)
- Andrzej Kazimierz Jaworek
- Department of Dermatology, Jagiellonian University Medical College, 31-501 Cracow, Poland;
- Correspondence:
| | - Jacek Cezary Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland;
| | - Przemysław Hałubiec
- Student Scientific Group, Department of Dermatology, Jagiellonian University Medical College, 31-501 Cracow, Poland;
| | - Anna Wojas-Pelc
- Department of Dermatology, Jagiellonian University Medical College, 31-501 Cracow, Poland;
| | - Jolanta Jaworek
- Department of Medical Physiology, Faculty of Health Sciences, Jagiellonian University Medical College, 31-126 Cracow, Poland;
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Chen Y, Lin L, Hong B, Karatela S, Pan W, Wu S, Tang N, Wang Y, Jing J, Cai L. Association of Allergic Symptoms in the First 2 Years of Life With Sleep Outcomes Among Chinese Toddlers. Front Pediatr 2021; 9:791369. [PMID: 35096706 PMCID: PMC8790483 DOI: 10.3389/fped.2021.791369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/20/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Previous studies have linked allergic symptoms to sleep in children, but the associations might be different when considering different types of allergic symptoms or sleep outcomes. Moreover, the combined effects of multiple allergic symptoms remain unclear in early life. This study aimed to investigate the associations between multiple allergic symptoms and sleep outcomes in early life. Methods: We included 673 toddlers aged 2 years from a birth cohort in Guangzhou, China. We identified allergic symptoms (skin, eyes and nose, gastrointestinal tract, mouth and lips, and wheeze) within 2 years via standard questionnaires. Sleep outcomes including sleep duration and quality over the past month were assessed based on the Chinese version of the Brief Infant Sleep Questionnaire. Associations between allergic symptoms and sleep outcomes were examined using multivariable linear regression and logistic regression. Results: Compared to children without allergic symptoms, children with allergic nasal and ocular symptoms had higher odds of frequent nighttime awakenings (OR = 1.41; 95% CI: 1.03, 1.93) and irregular sleep (OR = 1.45, 95% CI: 1.05, 2.00); children with allergic gastrointestinal symptoms slept 0.28 h less during nighttime (95% CI: -0.48, -0.07) and 0.25 h less per day (95% CI: -0.43, -0.08), and had 59% higher odds of irregular sleep (95% CI: 1.24, 2.04). We also found significant association of multiple allergic symptoms with shortened nighttime sleep duration and increased irregular sleep. Whereas, allergic skin, mouth and lips, and wheeze symptoms were not significantly associated with sleep outcomes. Conclusion: Allergic symptoms within 2 years of age were adversely associated with sleep outcomes, which highlight the importance of early screening of allergic symptoms in toddlers in order to improve their sleep outcomes.
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Affiliation(s)
- Yujing Chen
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Lizi Lin
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Bin Hong
- Department of Health Care, Maternal and Child Health Care Hospital of Yuexiu District, Guangzhou, China
| | - Shamshad Karatela
- Faculty of Health and Behavioural Sciences, Pharmacy Australia Centre of Excellence, University of Queensland, Woolloongabba, QLD, Australia.,Institute of Tropical Health and Medicine (AITHM), James Cook University, Townsville, QLD, Australia
| | - Wenting Pan
- Quality and Safety Management Office, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Shengchi Wu
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Nu Tang
- Department of Health Care, Foshan Women and Children Hospital, Foshan, China
| | - Yuxuan Wang
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Jin Jing
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Li Cai
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
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Bawany F, Northcott CA, Beck LA, Pigeon WR. Sleep Disturbances and Atopic Dermatitis: Relationships, Methods for Assessment, and Therapies. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:1488-1500. [PMID: 33321263 DOI: 10.1016/j.jaip.2020.12.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/25/2020] [Accepted: 12/01/2020] [Indexed: 12/28/2022]
Abstract
Atopic dermatitis is one of the most common chronic inflammatory skin conditions and is associated with sleep disturbances in 47% to 80% of children and 33% to 90% of adults. Herein, we review the literature on sleep disturbances experienced by patients with atopic dermatitis, as well as the mechanisms that may underlie this. We present subjective and objective methods for measuring sleep quantity and quality and discuss strategies for management. Unfortunately, the literature on this topic remains sparse, with most studies evaluating sleep as a secondary outcome using subjective measures. The development of portable, at-home methods for more objective measures offers new opportunities to better evaluate sleep disturbances in atopic dermatitis research studies and in clinical practice.
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Affiliation(s)
- Fatima Bawany
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY
| | - Carrie A Northcott
- Early Clinical Development, Digital Medicine and Translational Imaging, Pfizer, Inc, Cambridge, Mass
| | - Lisa A Beck
- Department of Dermatology, Medicine and Pathology, University of Rochester Medical Center, Rochester, NY
| | - Wilfred R Pigeon
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY.
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9
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Aquino MR, Kopel SJ, Dunsiger S, Koinis-Mitchell D. Sleep and asthma outcomes in urban children: Does atopic dermatitis increase risk? Ann Allergy Asthma Immunol 2020; 125:493-494. [PMID: 32585179 PMCID: PMC7529999 DOI: 10.1016/j.anai.2020.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/15/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Marcella R Aquino
- Allergy & Immunology Section, Department of Pediatrics, Hasbro Children's Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
| | - Sheryl J Kopel
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Shira Dunsiger
- Department of Behavioral and Social Sciences, Center for Health Promotion and Health Equity, Brown University, Providence, Rhode Island
| | - Daphne Koinis-Mitchell
- Allergy & Immunology Section, Department of Pediatrics, Hasbro Children's Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island; Department of Behavioral and Social Sciences, Center for Health Promotion and Health Equity, Brown University, Providence, Rhode Island
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10
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Torun EG, Ertugrul A, Tekguc DC, Bostanci I. Sleep Patterns and Development of Children with Atopic Dermatitis. Int Arch Allergy Immunol 2020; 181:871-878. [PMID: 32772024 DOI: 10.1159/000509402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/14/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Atopic dermatitis (AD) is a chronic inflammatory disease that begins in early childhood. Sleep problems have increased in children with AD. The aim of this study was to evaluate sleep patterns and the development of children with AD at an early age. METHODS This is a cross-sectional study consisting of a total of 80 children aged 0-36 months with AD. Patients were evaluated by the Brief Infant Sleep Questionnaire and International Guide for Monitoring Child Development. RESULTS The median age (IQR) of the patients was 6 (4.25-9) months, 63.7% of them were male and 50% of them had sleep problems. Male sex (OR: 3.78, p = 0.024, 95% CI, 0.083-0.837), patients with AD who were in the first 3 months after diagnosis (OR: 3.56; 95% CI, 1.220-10.43, p = 0.020), and moderate-severe AD (OR: 5.09; 95% CI, 1.649-15.748, p = 0.005) were determined as risk factors for sleep problems. In all, 12.5% of the patients needed support for one or more developmental areas (gross motor skills, expressive language and communication, receptive language, fine motor skills, relationship, and play). Developmental delay was higher in patients with sleep problems (p = 0.037). Multiple siblings (OR: 14.381; 95% CI, 1.557-132.871, p = 0.019) and the presence of sleep problems (OR: 8.011; 95% CI, 1.764-36.387, p = 0.024) were found to be risk factors for developmental delay. CONCLUSION Boys with moderate-severe AD within the first 3 months of diagnosis were at increased risk for sleep problems. Children with AD who have multiple siblings and sleep problems should be evaluated for developmental delay and monitored closely.
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Affiliation(s)
- Emine Gulsah Torun
- Department of Pediatrics, Health Sciences University Dr. Sami Ulus Maternity and Children Training and Research Hospital, Ankara, Turkey
| | - Aysegul Ertugrul
- Pediatric Allergy and Immunology Department, Health Sciences University Dr. Sami Ulus Maternity and Children Training and Research Hospital, Ankara, Turkey,
| | - Doga Ceren Tekguc
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, Health Sciences University Dr. Sami Ulus Maternity and Children Training and Research Hospital, Ankara, Turkey
| | - Ilknur Bostanci
- Pediatric Allergy and Immunology Department, Health Sciences University Dr. Sami Ulus Maternity and Children Training and Research Hospital, Ankara, Turkey
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Kahn D, Iturriaga C, Bertran K, Fernandez I, Perez-Mateluna G, Borzutzky A, Brockmann PE. Sleep quality in children with atopic dermatitis during flares and after treatment. Sleep Sci 2020; 13:172-175. [PMID: 32742589 PMCID: PMC7384531 DOI: 10.5935/1984-0063.20190139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 12/19/2019] [Indexed: 06/11/2023] Open
Abstract
BACKGROUND Little is known on sleep quality of children with atopic dermtitis (AD) during flares and how treatment impacts their sleep. The purpose of this study is to evaluate variations in sleep quality of children with AD during flares and its response to intensified treatment. MATERIAL AND METHODS Prospective case-crossover study in 10 children with moderate-severe AD. At baseline, AD severity was assessed using SCORAD and patients were prescribed intensified AD therapy. All subjects were monitored by actigraphy during 14 days and returned for SCORAD assessment. RESULTS Subjects' age was 5.6 ± 5.3 years; 50% were female. Sleep duration was decreased in all subjects and awakenings were increased in 90%. Parental perception of sleep significantly differed from actigraphy results: parents estimated less sleep duration and less awakenings. Nocturnal sleep efficiency at baseline was reduced in 50%. After intensified treatment, median SCORAD decreased from 58.5 to 31.3 (p=0.005), with significant improvement in sleep loss and pruritus visual analogue scales. Despite improvement of SCORAD and parental perception of sleep loss and pruritus, objective sleep duration and efficiency measured by actigraphy did not vary significantly after intensified treatment. Change in SCORAD, sleep loss and pruritus scales did not correlate significantly with change in sleep duration, efficiency or other actigraphic sleep quality measurements. CONCLUSIONS Children with moderate-severe AD have sleep quality abnormalities, with decreased sleep duration, low sleep efficiency and increased awakenings. Improvement in AD severity upon intensified AD treatment was associated with improved parental perception of sleep loss, but not of objective sleep quality assessed by actigraphy.
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Affiliation(s)
- Daniela Kahn
- Pontificia Universidad Catolica de Chile, Division of Pediatrics, School of Medicine - Santiago - Metropolitana - Chile
| | - Carolina Iturriaga
- Pontificia Universidad Católica de Chile, Santiago, Chile., Department of Pediatric Infectious Diseases and Immunology - Santiagio - Metropolitana - Chile
| | - Katalina Bertran
- Clinica Alemana Santiago UDD, Pediatrics - Santiago - Metropolitana - Chile
| | - Ignacio Fernandez
- Centro de Estudios para el Desarrollo, Desarrollo - Santiago - Metropolitana - Chile
| | - Guillermo Perez-Mateluna
- Pontificia Universidad Católica de Chile, Santiago, Chile., Department of Pediatric Infectious Diseases and Immunology - Santiagio - Metropolitana - Chile
| | - Arturo Borzutzky
- Pontificia Universidad Católica de Chile, Santiago, Chile., Department of Pediatric Infectious Diseases and Immunology - Santiagio - Metropolitana - Chile
| | - Pablo E. Brockmann
- Pontificia Universidad Catolica de Chile, Pediatric Sleep Center-Department Pediatric Cardiology and Pulmonology - Santiago - Metropolitana - Chile
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Cassanello P, Díez-Izquierdo A, Gorina N, Matilla-Santander N, Martínez-Sanchez JM, Balaguer A. Adaptation and study of the measurement properties of a sleep questionnaire for infants and pre-school children. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2017.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Sleep disorders and atopic dermatitis: A 2-way street? J Allergy Clin Immunol 2018; 142:1033-1040. [PMID: 30144472 DOI: 10.1016/j.jaci.2018.08.005] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/09/2018] [Accepted: 08/14/2018] [Indexed: 12/12/2022]
Abstract
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.
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Abstract
Atopic dermatitis is a chronic, pruritic inflammatory disease that often disrupts sleep in severely affected children, but there are limited studies to guide clinical management of these sleep problems. Disease control is crucial in improving sleep, but additional sleep aids may sometimes be helpful in decreasing scratching during the night. This review discusses the benefits and limitations of potential therapeutic agents available to manage sleep disturbances in children with atopic dermatitis.
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Affiliation(s)
- Devika Patel
- Department of Dermatology, Palo Alto Medical Foundation, Dublin, CA, USA
| | | | - Tor Shwayder
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
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Cassanello P, Díez-Izquierdo A, Gorina N, Matilla-Santander N, Martínez-Sanchez JM, Balaguer A. [Adaptation and study of the measurement properties of a sleep questionnaire for infants and pre-school children]. An Pediatr (Barc) 2018; 89:230-237. [PMID: 29317179 DOI: 10.1016/j.anpedi.2017.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/02/2017] [Accepted: 12/07/2017] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Although sleep disturbances in infants and toddlers are common, there is no suitable validated tool in Spanish to evaluate sleep disorders. The Brief Infant Sleep Questionnaire (BISQ) is a well-established multidimensional questionnaire widely used internationally. OBJECTIVES To adapt the BISQ questionnaire to Spanish and analyse its reliability and validity. To explore its feasibility, both in the clinical context, and in epidemiological research. METHODS Participants were parents of children between 3 and 30 months of age. The adaptation to Spanish (BISQ-E) was achieved by using both back translation and consensus, following the international guidelines.Reliability was determined by means of test-retest and measurement of agreement (Kappa value) between 2forms of administration of the questionnaire (self-administration and clinical interview). Construct validity was established by analysing its correlation with a sleep diary. RESULTS A total of 87 families/children participated. The test-retest reliability undertaken in 60 subjects was excellent; r = 0.848 (P<0.001). The kappa value was 0.939 (95% CI: 0.858-1.00, P<0.001).The agreement between BISQ-E and the sleep diary was analysed in 27 families/children, with statistically significant values being obtained for the following variables: bedtime (r = 0.731), hours of night sleep (r = 0.726), hours of daytime sleep (r = 0.867), and number of nocturnal awakenings (r = 0.888) (P < 0.001). CONCLUSIONS The Spanish adaptation of the BISQ shows overall adequate validity and reliability for the evaluation of sleep in infants and pre-school children. Its use as a clinical tool, or for clinical-epidemiological research studies, is feasible.
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Affiliation(s)
- Pia Cassanello
- Hospital Universitari General de Catalunya, Sant Cugat del Vallès (Barcelona), España; Universitat Internacional de Catalunya, Sant Cugat del Vallès (Barcelona), España
| | - Ana Díez-Izquierdo
- Hospital Universitari General de Catalunya, Sant Cugat del Vallès (Barcelona), España; Universitat Internacional de Catalunya, Sant Cugat del Vallès (Barcelona), España
| | - Nuria Gorina
- Hospital Universitari General de Catalunya, Sant Cugat del Vallès (Barcelona), España; Universitat Internacional de Catalunya, Sant Cugat del Vallès (Barcelona), España
| | - Nuria Matilla-Santander
- Hospital Universitari General de Catalunya, Sant Cugat del Vallès (Barcelona), España; Universitat Internacional de Catalunya, Sant Cugat del Vallès (Barcelona), España
| | - Jose M Martínez-Sanchez
- Hospital Universitari General de Catalunya, Sant Cugat del Vallès (Barcelona), España; Universitat Internacional de Catalunya, Sant Cugat del Vallès (Barcelona), España
| | - Albert Balaguer
- Hospital Universitari General de Catalunya, Sant Cugat del Vallès (Barcelona), España; Universitat Internacional de Catalunya, Sant Cugat del Vallès (Barcelona), España.
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