Association of Atopic Dermatitis With Sleep Quality in Children

Key Points

Question

Do children with atopic dermatitis experience impaired sleep duration and sleep quality throughout childhood, and do disease severity and activity affect their sleep?

Findings

In this longitudinal cohort study of 13 988 children, atopic dermatitis was statistically significantly associated with impaired sleep quality but not sleep duration throughout childhood. Sleep impairment was more common among children with more severe disease and with comorbid asthma or allergic rhinitis, and the risk remained elevated even among children with mild and inactive atopic dermatitis.

Meaning

These findings suggest that clinicians should consider sleep quality among all children with atopic dermatitis, especially those with comorbid asthma or allergic rhinitis and severe disease; it appears interventions to improve sleep quality are needed for this population.

Abstract

Importance

Pruritus, a hallmark of atopic dermatitis (AD), is thought to disrupt sleep, yet little is known about how variations in disease activity and severity of this common childhood condition may be associated with sleep patterns over time.

Objective

To determine whether children with active AD have impaired sleep duration and quality at multiple time points throughout childhood and whether disease severity affects sleep outcomes.

Design, Setting, and Participants

This longitudinal cohort study used data of children enrolled in the Avon Longitudinal Study of Parents and Children, a population-based birth cohort in Avon, United Kingdom. Participants were children (N = 13 988) alive at 1 year and followed up with repeated measures of self-reported AD and sleep through 16 years of age. This study was based on data collected from 1990 to 2008. Data analysis was performed from September 2017 to September 2018.

Main Outcomes and Measures

Standardized measure of sleep duration and composite measure of sleep quality, including nighttime awakenings, early morning awakenings, difficulty falling asleep, and nightmares, were repeated at multiple time points between 2 and 16 years of age.

Results

The study sample comprised 13 988 children (7220 male [51.6%]) followed up for a median (interquartile range [IQR]) duration of 11 (5-14) years. Of this total, 4938 children (35.3%) met the definition of having atopic dermatitis between 2 and 16 years of age. Total sleep duration was similar between children with active AD and without AD at all ages, and the average estimated difference across childhood was a clinically negligible difference of 2 minutes less per day for children with AD (95% CI, −4 to 0 minutes). In contrast, children with active AD were more likely to report worse sleep quality at all time points, with a nearly 50% higher odds of experiencing more sleep-quality disturbances (adjusted odds ratio [aOR], 1.48; 95% CI, 1.33 to 1.66). Children with more severe active disease (quite bad or very bad AD: aOR, 1.68; 95% CI, 1.42 to 1.98) and with comorbid asthma or allergic rhinitis (aOR, 1.79; 95% CI, 1.54 to 2.09) had worse sleep quality. However, even children with mild AD (OR, 1.40; 95% CI, 1.27 to 1.54) or inactive AD (OR, 1.41; 95% CI, 1.28 to 1.55) had statistically significantly increased odds of impaired sleep quality.

Conclusions and Relevance

Atopic dermatitis appeared to be associated with impaired sleep quality throughout childhood; thus, it is suggested that clinicians should consider sleep quality among all children with AD, especially those with comorbid asthma or allergic rhinitis and severe disease, and that interventions to improve sleep quality are needed.

Abstract

This cohort study examines the prevalence and severity of atopic dermatitis as well as sleep duration and quality at multiple periods among young children enrolled in the Avon Longitudinal Study of Parents and Children in the United Kingdom.