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Sleep Disturbance and Sleep-Related Impairment in Adults With Atopic Dermatitis

A Cross-sectional Study

Li, Jennifer C., BS*; Fishbein, Anna, MD†‡; Singam, Vivek, BLA*; Patel, Kevin R., BS*; Zee, Phyllis C., MD, PhD‡§; Attarian, Hrayr, MD‡§; Cella, David, PhD; Silverberg, Jonathan I., MD, PhD, MPH*∥¶#

doi: 10.1097/DER.0000000000000401

Background Little is known about the impact of sleep disturbances (SD) or sleep-related impairment (SRI) in adults with AD or their relationship with severity of AD and itch and other predictors.

Objective The aim of this study was to determine the relationship between AD severity, SD, and SRI.

Methods We conducted a prospective online questionnaire-based study of 287 adults with AD, including assessment of AD severity by Patient-Oriented Eczema Measure, self-reported global AD severity, Self-Assessed Eczema Area and Severity Index and visual analog scale–itch, Patient-Reported Outcome Measurement Information System SD and SRI individual items, and T scores.

Results Adults with AD commonly endorsed all SD and SRI symptoms examined; only 58 (21.8%) reported having good or very good sleep quality in the past week. However, only a minority of adults with AD endorsed a more profound impact from these individual aspects of SD and SRI in the past week or Patient-Reported Outcome Measurement Information System T scores greater than 55. In particular, SD and SRI were associated with severe or very severe AD (Patient-Oriented Eczema Measure, self-reported severity, visual analog scale–itch, and/or Self-Assessed Eczema Area and Severity Index). Sleep-related impairment was also associated with comorbid hay fever and/or anxiety.

Conclusions This study suggests that SD and SRI are common in adults with AD, particularly those with severe diseases. Sleep disturbances and SRI should be considered when assessing burden of AD and therapeutic decisions.

From the Departments of *Dermatology and

Allergy and Immunology,

Center for Circadian and Sleep Medicine, and Departments of


Medical Social Sciences, and

Preventive Medicine, Feinberg School of Medicine at Northwestern University; and

#Northwestern Medicine Multidisciplinary Eczema Center, Chicago, IL.

Address reprint requests to Jonathan I. Silverberg, MD, PhD, MPH, Department of Dermatology, Northwestern University Feinberg School of Medicine, Suite 1600, 676 N St Clair St, Chicago, IL 60611. E-mail:

This publication was made possible with support from the Agency for Healthcare Research and Quality (grant K12HS023011) and the Dermatology Foundation.

The authors have no conflicts of interest to declare.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

© 2018 American Contact Dermatitis Society
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