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Gillow GM, Robins C, Palomo R, Sheldon SS, Fishbein AB. 0987 Characterizing Scratch And Limb Movements In Atopic Dermatitis During Sleep. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
Children with atopic dermatitis (AD) experience significant sleep disruption due to nocturnal scratching. Our group has found distinct patterns of limb movements in contrast to control and PLMD patients. To expand on previous findings, our objective was to characterize timing and duration of scratch v. non-scratch movement in children with AD coincidentally undergoing polysomnography (PSG).
Methods
Retrospective chart review of PSG, video footage was synchronized with the EEG and limb electrode readings using a time/date generator and was then operationally classified as either scratching or non-scratching movement. Analysis of data was done using SPSS and groups were compared using an ANOVA.
Results
We analyzed four previously completed sleep studies in children with atopic dermatitis (1 female and 3 males), mean age years±SD 11.3±1.0, mean BMI±SD 21.9±7.1, mean AHI±SD 2.3±0.8. Average scratch duration was not significantly different by sleep stage, N1v.N2v.N3v.REM (mean scratch duration in seconds±SD= 9.0±1.5 v 6.3±3.2 v. 11.9±11.8 v. 6.3±7.3, respectively p=0.65). However, frequency of scratching events were more common during N2v.N1v.N3v.REM (mean scratching events±SD= 9.3±3.9 v 3.8±1.7 v. 4.3±4.3 v. 1.3±1.9, respectively p=0.02). Yet, given the duration of total time spent in sleep stages, minutes of scratching events occupied the largest percentage of N1v.N2v.N3v.REM (mean% ±SD= 3.9±0.9 v. 0.6±0.4 v. 0.4±0.2 v. 0.3±0.5, respectively, p<0.01). Interestingly, non-scratch related movements were not significantly different between sleep stages (p=0.2). However, non-scratch related movements trended to occupy the largest percentage of N1v.N2v.N3v.REM (mean% ±SD= 9.3±7.7 v. 2.1±1.6 v. 1.5±0.8 v. 1.9±1.4, respectively, p=0.05).
Conclusion
Our results suggest that scratching episodes in children with AD occur most commonly during N2 sleep, but occupy the largest % of N1 sleep. Future work will include comparing these limb movements to age and gender-matched allergic rhinitis patients.
Support
This study was unfunded.
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Affiliation(s)
- G M Gillow
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - C Robins
- Ann & Robert H. Lurie Children’s Hospital, Sleep Medicine Center, Chicago, IL
| | - R Palomo
- Ann & Robert H. Lurie Children’s Hospital, Sleep Medicine Center, Chicago, IL
| | - S S Sheldon
- Ann & Robert H. Lurie Children’s Hospital, Division of Pediatric Pulmonary and Sleep Medicine, Chicago, IL
| | - A B Fishbein
- Ann & Robert H. Lurie Children’s Hospital, Division of Pediatric Allergy & Immunology, Chicago, IL
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Strom MA, Fishbein AB, Paller AS, Silverberg JI. Association between atopic dermatitis and attention deficit hyperactivity disorder in U.S. children and adults. Br J Dermatol 2016; 175:920-929. [PMID: 27105659 DOI: 10.1111/bjd.14697] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is associated with chronic itch, allergic disease and sleep disturbance, all of which might increase the risk of attention deficit (hyperactivity) disorder (ADD/ADHD). Previous analyses have found a consistent association between AD and ADD/ADHD, although the underlying factors contributing to such an association remain underexplored. Additionally, the relationship has been underexplored in adults. OBJECTIVES To determine if childhood and adult AD and AD severity are associated with ADD/ADHD and to delineate the factors contributing to such an association. METHODS We analysed data on 354 416 children aged 2-17 years and 34 613 adults age 18+ years from 19 U.S. population-based surveys, including the National Health Interview Survey 1997-2013 and the National Survey of Children's Health 2003/4 and 2007/8. RESULTS In multivariate models adjusting for age, sex, sociodemographics, allergic disease and healthcare utilization, AD was associated with ADD/ADHD in both children [adjusted odds ratio (95% confidence interval), 1·14 (1·03-1·26)] and adults [1·61 (1·25-2·06)]. Children with both severe AD and only 0-3 nights of adequate sleep per week had much higher odds of ADD/ADHD [16·83 (7·02-40·33)] than those with 0-3 nights of adequate sleep per week [1·83 (1·47-2·26)] or mild-moderate AD alone [1·56 (1·22-1·99)]. AD was most strongly associated with severe ADHD. AD unaccompanied by other allergic disease was also associated with increased risk of ADD/ADHD in children. Among children with AD, history of anaemia, headaches and obesity were associated with even higher odds of ADD/ADHD. Asthma, insomnia and headaches increased the odds of ADHD in adults with AD, although underweight body mass index was protective. CONCLUSIONS Atopic dermatitis is associated with increased odds of ADD/ADHD in adults and children. Several factors increase the risk of ADHD in adults and children with AD.
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Affiliation(s)
- M A Strom
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Suite 1600, 676 N. St. Clair St, Chicago, IL, 60611, U.S.A
| | - A B Fishbein
- Department of Allergy & Immunology, Feinberg School of Medicine at Northwestern University, Suite 1600, 676 N. St. Clair St, Chicago, IL, 60611, U.S.A.,Department of Pediatrics, Feinberg School of Medicine at Northwestern University, Suite 1600, 676 N. St. Clair St, Chicago, IL, 60611, U.S.A
| | - A S Paller
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Suite 1600, 676 N. St. Clair St, Chicago, IL, 60611, U.S.A.,Department of Pediatrics, Feinberg School of Medicine at Northwestern University, Suite 1600, 676 N. St. Clair St, Chicago, IL, 60611, U.S.A.,Northwestern Medicine Multidisciplinary Eczema Center, Chicago, IL, U.S.A
| | - J I Silverberg
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Suite 1600, 676 N. St. Clair St, Chicago, IL, 60611, U.S.A. .,Northwestern Medicine Multidisciplinary Eczema Center, Chicago, IL, U.S.A. .,Department of Preventive Medicine, Feinberg School of Medicine at Northwestern University, Suite 1600, 676 N. St. Clair St, Chicago, IL, 60611, U.S.A. .,Department of Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Suite 1600, 676 N. St. Clair St, Chicago, IL, 60611, U.S.A.
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Qamar N, Fishbein AB, Erickson KA, Cai M, Szychlinski C, Bryce PJ, Schleimer RP, Fuleihan RL, Singh AM. Naturally occurring tolerance acquisition to foods in previously allergic children is characterized by antigen specificity and associated with increased subsets of regulatory T cells. Clin Exp Allergy 2016; 45:1663-72. [PMID: 25989379 DOI: 10.1111/cea.12570] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 04/04/2015] [Accepted: 04/27/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Food allergy affects approximately 6-8% of children, and increasing in prevalence. Some children naturally outgrow their food allergy without intervention, but the mechanisms by which this occurs remain poorly understood. We sought to investigate the role of regulatory T cells in the development of naturally acquired tolerance. METHODS Fifty-eight children (1-18 years) with either egg or peanut allergy, recent acquisition of natural tolerance to egg or peanut, or no food allergy were studied. Peripheral blood mononuclear cells (PBMC) from these groups were stimulated with relevant antigen for 48 h and flow cytometry performed to characterize both surface (CD3, CD4, CD25, CD14, CD19, and CD127) and intracellular markers (IL-10, Foxp3, and IL-5). RESULTS Resting PBMC from naturally tolerant patients had significantly increased CD3+CD4+CD25+CD127loFoxp3+ cells, when compared to allergic or control patients (mean 6.36 vs. 2.37 vs. 2.62%, respectively, P < 0.05). Upon stimulation with relevant antigen, naturally tolerant patients also had increased IL-10-expressing CD25+CD127lo cells (6.33 vs. 1.65 vs. 0.7, P < 0.01), Foxp3+ cells (mean 12.6 vs. 5.42 vs. 3%, P < 0.01), and CD4+ cells (mean 4.48 vs. 1.59 vs. 0.87%, P < 0.01); the increase was not observed in PBMCs from allergic or control patients. Additionally, this upregulation was only seen with relevant antigen stimulation and not upon stimulation with unrelated antigen. CONCLUSION The increased CD3+CD4+CD25+CD127lo cells at baseline and upon stimulation and increased induction of IL-10-producing cells of several types, including Tr1 cells, from naturally tolerant patients suggests an important role for regulatory T cell subsets in the acquisition of natural tolerance.
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Affiliation(s)
- N Qamar
- Division of Allergy and Immunology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA
| | - A B Fishbein
- Division of Allergy and Immunology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA
| | - K A Erickson
- Division of Allergy & Immunology, Department of Medicine, Northwestern Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - M Cai
- Division of Allergy and Immunology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA
| | - C Szychlinski
- Division of Allergy and Immunology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA
| | - P J Bryce
- Division of Allergy & Immunology, Department of Medicine, Northwestern Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - R P Schleimer
- Division of Allergy & Immunology, Department of Medicine, Northwestern Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - R L Fuleihan
- Division of Allergy and Immunology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA
| | - A M Singh
- Division of Allergy and Immunology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA.,Division of Allergy & Immunology, Department of Medicine, Northwestern Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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