Sleep disturbance in adult dermatologic patients: A cross-sectional study on prevalence, burden, and associated factors - 29/05/21

Doi : 10.1016/j.jaad.2021.04.015

Max Spindler, MD, Katarzyna Przybyłowicz, MD, Marlena Hawro, PhD, Karsten Weller, MD, Ulrich Reidel, MD, Martin Metz, MD, Marcus Maurer, MD, Tomasz Hawro, MD ^⁎
Dermatological Allergology, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany

^∗Correspondence and reprint requests to: Tomasz Hawro, MD, Dermatological Allergology, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.Dermatological AllergologyDepartment of Dermatology and AllergyCharité-Universitätsmedizin BerlinCharitéplatz 1Berlin10117Germany

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Abstract

Background

Sleep disturbance remains insufficiently characterized in many dermatoses.

Objective

To investigate the prevalence, burden, and factors associated with sleep disturbance in dermatologic patients.

Methods

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.

Results

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.

Conclusion

Sleep disturbance is prevalent in dermatologic patients and constitutes a considerable burden.

Clinical implication

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.

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Key words : activity, anxiety, depression, pruritus, psychological distress, quality of life, sleep quality, work productivity

Abbreviations used : AE, AD, BP, CBCL, CP, CPG, CSU, CTCL, HADS, HADS-A, HADS-D, HADS-total, HR-QoL, PSQI, PSQI-total, UV, VAS

Plan

Introduction

Methods

Patients and study design

Validated instruments

Nonvalidated questions

Statistical analysis

Results

Prevalence and level of sleep disturbance are high in patients with skin diseases

Intense pruritus predicts sleep disturbance and poor sleep is associated with pruritus exacerbation occurring around normal bedtime

Female sex, obesity, higher number of comorbidities, unemployment, and living alone are associated with poor sleep

Poor sleep is associated with depression, anxiety, psychological distress, diminished HR-QoL, decreased work productivity, and reduced activity

Psychological distress is the main predictor of sleep disturbance and mediates the link between pruritus and sleep disturbance

Discussion

Conclusion

	Funding sources: This study was funded, in part, by an unrestricted grant from Leo Pharma (112299).
	IRB approval status. Ethics Committee of Charité - Universitätsmedizin Berlin (EA1/007/14).