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

Published:April 14, 2021DOI:https://doi.org/10.1016/j.jaad.2021.04.015

      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.

      Key words

      Abbreviations used:

      AE (histaminergic angioedema), AD (atopic dermatitis), BP (bullous pemphigoid), CBCL (cutaneous B-cell lymphoma), CP (chronic pruritus on unaltered skin), CPG (chronic prurigo), CSU (chronic spontaneous urticaria), CTCL (cutaneous T-cell lymphoma), HADS (hospital Anxiety and Depression Scale), HADS-A (anxiety subscale), HADS-D (depression subscale), HADS-total (summed totalscore), HR-QoL (health-related quality of life), PSQI (Pittsburgh Sleep Quality Index), PSQI-total (Pittsburgh Sleep Quality Index total score), UV (urticarial vasculitis), VAS (visual analog scale)
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