Actigraphy assessment of sleep disturbance in patients with atopic dermatitis: An objective life quality measure

doi:10.1067/mai.2003.174

Journal of Allergy and Clinical Immunology

Volume 111, Issue 3, March 2003, Pages 598-602

https://doi.org/10.1067/mai.2003.174 Get rights and content

Abstract

Background: Patients with atopic dermatitis (AD) frequently report compromised quality of life because of disturbed sleep and daytime fatigue secondary to their skin disease, but few studies provide objective measurement of sleep change in this population. Objective: The purpose of this investigation was to contrast subjective and objective measures of sleep quality in patients with AD. Methods: Fourteen adult patients with AD and 14 adult control subjects with no skin disease wore actigraphs for 1 week and completed questionnaires about sleep, itch, and quality of life. Results: As measured by self-report and actigraphy, the AD group slept more poorly and reported more daytime fatigue than the control group. Actigraphy alone was correlated with itch and quality of life and was able to discriminate movement during sleep, number of awakenings, minutes asleep, and minutes awake. Conclusions: Results from this study demonstrate that sleep is significantly compromised in patients with AD. Patients' perception of their sleep provides less detail and accuracy than actigraphy. The actigraph is an objective, unobtrusive measure of sleep at home in patients with skin disease and can provide an important outcome measure in clinical trials. (J Allergy Clin Immunol 2003;111:598-602.)

Section snippets

Subjects

Fourteen adult patients with AD (11 female, 3 male; mean age, 40.1 ± 12.8 years) and 14 adults without skin disease (11 female, 3 male; mean age, 40.0 ± 8.4 years) participated in this study. All patients had moderate to severe AD; the percent of body surface involvement ranged from 5% to 55% (mean, 21.1%; SD, 17.3%). Sleep history was not examined in determining eligibility.

Procedures

Each participant attended 2 study visits. At the first visit, informed consent was obtained and the participant completed

Self-report sleep measure

Mean scores of the AD group were significantly different from those of the control group on 3 of 8 variables and the global score from the PSQI (P < .05; Mann-Whitney U test; Table I). The AD group, on average, reported lower sleep quality and more awakening and daytime dysfunction than did the control group. No significant between-group differences emerged with respect to the sleep latency, duration, efficiency, or sleep disturb-ance variables, though sleep efficiency approached significance (P

Discussion

This study demonstrates through objective measurement that adults with AD sleep less well than those without the disease. Furthermore, sleep loss secondary to AD is associated with increased itching and decreased quality of life. There were no differences between patients with AD and control patients in sleep latency or total amount of time spent in bed; only 40 minutes separated the 2 groups with respect to the total amount of time spent sleeping each night. Most striking were the increased

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2023, Journal of the American Academy of Dermatology
Most children with atopic dermatitis (AD) experience sleep disturbance, but reliable and valid assessment tools are lacking.
To test the Patient-Reported Outcomes Measurement Information System (PROMIS) sleep measures in pediatric AD and to develop an algorithm to screen, assess, and intervene to reduce sleep disturbance.
A cross-sectional study was conducted with children with AD ages 5 to 17 years and 1 parent (n = 61), who completed sleep, itch, and AD-specific questionnaires; clinicians assessed disease severity. All children wore actigraphy watches for a 1-week objective sleep assessment.
PROMIS sleep disturbance parent proxy reliability was high (Cronbach α = 0.90) and was differentiated among Patient-Oriented Eczema Measure (POEM)–determined disease severity groups (mean ± standard deviation in mild vs moderate vs severe was 55.7 ± 7.5 vs 59.8 ± 10.8 vs 67.1 ± 9.5; P < .01). Sleep disturbance correlated with itch (numeric rating scale, r = 0.48), PROMIS sleep-related impairment (r = 0.57), and worsened quality of life (Children's Dermatology Life Quality Index, r = 0.58), with all P values less than .01. Positive report on the POEM sleep disturbance question has high sensitivity (95%) for PROMIS parent proxy–reported sleep disturbance (T-score ≥ 60). An algorithm for screening and intervening on sleep disturbance was proposed.
This was a local sample.
Sleep disturbance in pediatric AD should be screened using the POEM sleep question, with further assessment using the PROMIS sleep disturbance measure or objective sleep monitoring if needed.
Clinical Relevance of the Microbiome in Pediatric Skin Disease: A Review
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Exacerbating factors and disease burden in patients with atopic dermatitis
2022, Allergology International
The number of patients with atopic dermatitis is on the rise worldwide, and Japan is no exception. According to recent estimates of the percentage of patients with atopic dermatitis in Japan by age, the majority of patients are between 20 and 44 years old. Because the peak age of onset of atopic dermatitis is during infancy, many patients may experience prolonged symptoms from infancy to adulthood. A prolonged clinical course also increases the burden of atopic dermatitis on affected patients. Decreased productivity due to work disruptions, reduced daily activity, higher direct medical costs, fatigue, and daytime sleepiness due to sleep disturbances are typical burdens on patients with atopic dermatitis. In order to reduce these burdens, it is necessary to shorten its clinical course and achieve long-term control without relying on medications, possibly by using avoidance or coping measures of aggravating factors. Typical aggravating factors of atopic dermatitis include irritant dermatitis, food allergy in children, sweating, and psychological stress in adults. Food allergy places a heavy burden on the quality of life of affected patients and their families. The effectiveness of educational interventions for sweating and psychological stress is unclear. We must also evaluate the economic burden and cost-effectiveness of interventions on the patient as aggravating factors to be addressed.
Use of technology for the objective evaluation of scratching behavior: A systematic review
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Pruritus is a common symptom across various dermatologic conditions, with a negative impact on quality of life. Devices to quantify itch objectively primarily use scratch as a proxy. This review compares and evaluates the performance of technologies aimed at objectively measuring scratch behavior.
Articles identified from literature searches performed in October 2020 were reviewed and those that did not report a primary statistical performance measure (eg, sensitivity, specificity) were excluded. The articles were independently reviewed by 2 authors.
The literature search resulted in 6231 articles, of which 24 met eligibility criteria. Studies were categorized by technology, with actigraphy being the most studied (n = 21). Wrist actigraphy's performance is poorer in pruritic patients and inherently limited in finger-dominant scratch detection. It has moderate correlations with objective measures (Eczema and Area Severity Index/Investigator's Global Assessment: r_s(ρ) = 0.70-0.76), but correlations with subjective measures are poor (r² = 0.06, r_s(ρ) = 0.18-0.40 for itch measured using a visual analog scale). This may be due to varied subjective perception of itch or actigraphy's underestimation of scratch.
Actigraphy's large variability in performance and limited understanding of its specificity for scratch merits larger studies looking at validation of data analysis algorithms and device performance, particularly within target patient populations.
Sleep disturbance in adult dermatologic patients: A cross-sectional study on prevalence, burden, and associated factors
2021, Journal of the American Academy of Dermatology
Sleep disturbance remains insufficiently characterized in many dermatoses.
To investigate the prevalence, burden, and factors associated with sleep disturbance in dermatologic patients.
We recruited 800 patients and recorded pruritus characteristics and sociodemographic and clinical parameters. Validated questionnaires were used to assess sleep disturbance, psychological distress, health-related quality of life, and work productivity.
Two thirds of patients met criteria of poor sleep, which was associated with psychological distress, diminished health-related quality of life, and lost work productivity. Patients with average and maximum pruritus on the visual analog scale exceeding 5 and 6.5 points, respectively, were at high risk of suffering pruritus-related sleep disturbance. Overall pruritus intensity and its nocturnal exacerbation contributed independently to sleep disturbance. Psychological distress was of even higher impact on sleep than pruritus and almost a third of the relationship between pruritus intensity and sleep was mediated by psychological distress.
Sleep disturbance is prevalent in dermatologic patients and constitutes a considerable burden.
Dermatologic patients with intense pruritus and psychological distress should be examined for sleep disorders. Adequate antipruritic therapy and complementary psychotherapy in affected patients may help them regain restorative sleep.
Nocturnal pruritus and sleep disturbance associated with dermatologic disorders in adult patients
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Nocturnal pruritus (NP) is a relatively common reason for dermatologic consultation. Its pathophysiology is partially understood. Skin conditions such as atopic dermatitis, psoriasis, urticaria, and prurigo nodularis are well-described causes of NP. The most distressing sequela of NP is sleep deficit, which can lead to physical and mental disturbances (e.g., daytime somnolence and fatigue) and negative emotional states that profoundly affect quality of life. However, this aspect of NP is often overlooked by dermatologists. It is essential to assess sleep quality in such patients and adopt appropriate measures to arrest the problem at an early stage. We conducted an evidence-based literature review to highlight the pathogenetic mechanisms of NP, identify dermatologic etiologies, and explore methods that have been used to assess the quality of sleep. Furthermore, we performed a systematic review of studies on sleep disturbance relevant to NP in patients with dermatologic conditions. Finally, we discuss the evidence on treatment options for NP and indicate therapies that may target both NP and sleep disturbance.

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^☆: Reprint requests: Donald Y. M. Leung, MD, PhD, National Jewish Medical and Research Center, 1400 Jackson Street, Room K926i, Denver, CO 80206.

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Dermatologic and Ocular DiseasesActigraphy assessment of sleep disturbance in patients with atopic dermatitis: An objective life quality measure☆

Abstract

Section snippets

Subjects

Procedures

Self-report sleep measure

Discussion

J Allergy Clin Immunol

Immunol Allergy Clin No Am

Physiol Behav

Dermatology Life Quality Index (DLQI)—a simple practical measure for routine clinical use

Clin Exp Dermatol

Use of a wrist activity monitor for the measurement of nocturnal scratching in patients with atopic dermatitis

Br J Dermatol

Sleep disturbances in children with atopic dermatitis

Arch Pediatr Adolesc Med

Sleep fragmentation in children with atopic dermatitis

Arch Pediatr Adolesc Med

Dermatologic and Ocular Diseases
Actigraphy assessment of sleep disturbance in patients with atopic dermatitis: An objective life quality measure☆