Poor sleep quality in children with atopic dermatitis and its effects on behavior: A multicenter cross-sectional study from a low-middle-income country.
Malaysia
atopic dermatitis
behavior
child
sleep quality
Journal
Pediatrics international : official journal of the Japan Pediatric Society
ISSN: 1442-200X
Titre abrégé: Pediatr Int
Pays: Australia
ID NLM: 100886002
Informations de publication
Date de publication:
Jan 2023
Jan 2023
Historique:
revised:
16
12
2022
received:
27
11
2022
accepted:
12
01
2023
medline:
31
3
2023
pubmed:
17
1
2023
entrez:
16
1
2023
Statut:
ppublish
Résumé
Sleep disturbance in children with atopic dermatitis (AD) frequently goes unnoticed and can be associated with behavioral challenges. The aims of this study were to determine (a) the prevalence and factors associated with sleep disturbance and behavioral problems and (b) the correlation between sleep disturbance and behavioral problems in children with AD. This cross-sectional study involved children aged 4-12 years old with moderate to severe AD. Age and sex-matched healthy children were recruited as the comparison group. The Children's Sleep Habits Questionnaire (CSHQ) and the Strengths and Difficulties Questionnaire (SDQ) were used to assess sleep disturbance and behavioral problems, respectively. Higher scores in both questionnaires signify more disturbance. Seventy patients and 141 controls were recruited. Median (interquartile range) age of patients was 5 (4,8) years. Patients had later sleep time (p < 0.001), longer night awakening (p < 0.001), and shorter sleep duration (p < 0.001) compared to controls. CSHQ total scores and all its domains, except for sleep-disordered breathing were significantly higher in patients compared to controls. Patients also had significantly higher SDQ total difficulties scores in all domains, except for peer problems. Severity of AD was significantly associated with high CSHQ and SDQ scores. There was a moderate positive correlation between the total CSHQ score and total SDQ score in patients (r = 0.532). Children with moderate-to-severe AD had significantly more sleep disturbance and more behavioral problems than their healthy peers. Sleep disturbance had a positive correlation with behavioral problems. Severity of AD was associated with sleep disturbance and behavioral problems.
Sections du résumé
BACKGROUND
BACKGROUND
Sleep disturbance in children with atopic dermatitis (AD) frequently goes unnoticed and can be associated with behavioral challenges. The aims of this study were to determine (a) the prevalence and factors associated with sleep disturbance and behavioral problems and (b) the correlation between sleep disturbance and behavioral problems in children with AD.
METHODS
METHODS
This cross-sectional study involved children aged 4-12 years old with moderate to severe AD. Age and sex-matched healthy children were recruited as the comparison group. The Children's Sleep Habits Questionnaire (CSHQ) and the Strengths and Difficulties Questionnaire (SDQ) were used to assess sleep disturbance and behavioral problems, respectively. Higher scores in both questionnaires signify more disturbance.
RESULTS
RESULTS
Seventy patients and 141 controls were recruited. Median (interquartile range) age of patients was 5 (4,8) years. Patients had later sleep time (p < 0.001), longer night awakening (p < 0.001), and shorter sleep duration (p < 0.001) compared to controls. CSHQ total scores and all its domains, except for sleep-disordered breathing were significantly higher in patients compared to controls. Patients also had significantly higher SDQ total difficulties scores in all domains, except for peer problems. Severity of AD was significantly associated with high CSHQ and SDQ scores. There was a moderate positive correlation between the total CSHQ score and total SDQ score in patients (r = 0.532).
CONCLUSIONS
CONCLUSIONS
Children with moderate-to-severe AD had significantly more sleep disturbance and more behavioral problems than their healthy peers. Sleep disturbance had a positive correlation with behavioral problems. Severity of AD was associated with sleep disturbance and behavioral problems.
Types de publication
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e15473Informations de copyright
© 2023 Japan Pediatric Society.
Références
Kay J, Gawkrodger DJ, Mortimer MJ, Jaron AG. The prevalence of childhood atopic eczema in a general population. J Am Acad Dermatol. 1994;30(1):35-9.
Arkwright PD, Motala C, Subramanian H, Spergel J, Schneider LC, Wollenberg A, et al. Management of difficult-to-treat atopic dermatitis. J Allergy Clin Immunol Pract. 2013;1(2):142-51.
Lyons JJ, Milner JD, Stone KD. Atopic dermatitis in children: clinical features, pathophysiology, and treatment. Immunol Allergy Clin North Am. 2015;35(1):161-83.
Goh YY, Keshavarzi F, Chew YL. Prevalence of atopic dermatitis and pattern of drug therapy in Malaysian children. Dermatitis. 2018;29(3):151-61.
Asher MI, Montefort S, Bjorksten B, Lai CK, Strachan DP, Weiland SK, et al. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC phases one and three repeat multicountry cross-sectional surveys. Lancet. 2006;368(9537):733-43.
Fishbein AB, Hamideh N, Lor J, Zhao S, Kruse L, Mason M, et al. Management of Atopic Dermatitis in children younger than two years of age by community pediatricians: a survey and chart review. J Pediatr. 2020;221:138-44.e3.
Low DW, Jamil A. Food Restriction, Nutrition Status, and Growth in Toddlers with Atopic Dermatitis. Pediatr Dermatol. 2020;37(1):69-77.
Camfferman D, Kennedy JD, Gold M, Martin AJ, Lushington K. Eczema and sleep and its relationship to daytime functioning in children. Sleep Med Rev. 2010;14(6):359-69.
Ghani AAA, Noor NM, Muhamad R, Ismail Z, Norhayati N. Quality of life and its associated factors among children with atopic eczema in Kelantan, Malaysia. Int J Collab Res Intern Med Public Health. 2012;4(11):1816-1827.
Aziah MS, Rosnah T, Mardziah A, Norzila MZ. Childhood atopic dermatitis: a measurement of quality of life and family impact. Med J Malaysia. 2002;57(3):329-39.
Paruthi S, Brooks LJ, D'Ambrosio C, Hall WA, Kotagal S, Lloyd RM, et al. Consensus statement of the American Academy of sleep medicine on the recommended amount of sleep for healthy children: methodology and Discussion. J Clin Sleep Med. 2016;12(11):1549-61.
Firouzi S, Bee Koon P, Noor MI, Sadeghilar A. Sleep pattern and sleep disorders among a sample of Malaysian children. Sleep Biol Rhythms. 2013;11(3):185-93.
Ramirez FD, Chen S, Langan SM, Prather AA, McCulloch CE, Kidd SA, et al. Association of Atopic Dermatitis with Sleep Quality in children. JAMA Pediatr. 2019;173(5):e190025.
Urrutia-Pereira M, Solé D, Rosario N, Neto H, Acosta V, Almendarez C, et al. Sleep-related disorders in Latin-American children with atopic dermatitis: a case control study. Allergol Immunopathol. 2017;45(3):276-82.
Klinnert MD, Booster G, Copeland M, Darr JM, Meltzer LJ, Miller M, et al. Role of behavioral health in management of pediatric atopic dermatitis. Ann Allergy Asthma Immunol. 2018;120(1):42-8.e8.
Smedje H, Broman JE, Hetta J. Associations between disturbed sleep and behavioural difficulties in 635 children aged six to eight years: a study based on parents' perceptions. Eur Child Adolesc Psychiatry. 2001;10(1):1-9.
Schmitt J, Chen CM, Apfelbacher C, Romanos M, Lehmann I, Herbarth O, et al. Infant eczema, infant sleeping problems, and mental health at 10 years of age: the prospective birth cohort study LISAplus. Allergy. 2011;66(3):404-11.
Hanifin JM. Diagnostic features of atopic dermatitis. Acta Derm Venereol. 1980;92:44-7.
Barbier N, Paul C, Luger T, Allen R, De Prost Y, Papp K, et al. Validation of the eczema area and severity index for atopic dermatitis in a cohort of 1550 patients from the pimecrolimus cream 1% randomized controlled clinical trials programme. Br J Dermatol. 2004;150(1):96-102.
Chopra R, Vakharia PP, Sacotte R, Patel N, Immaneni S, White T, et al. Severity strata for eczema area and severity index (EASI), modified EASI, scoring atopic dermatitis (SCORAD), objective SCORAD, atopic dermatitis severity index and body surface area in adolescents and adults with atopic dermatitis. Br J Dermatol. 2017;177(5):1316-21.
Owens JA, Spirito A, McGuinn M. The Children's sleep habits questionnaire (CSHQ): psychometric properties of a survey instrument for school-aged children. Sleep. 2000;23(8):1043-51.
Goodman R. The strengths and difficulties questionnaire: a research note. J Child Psychol Psychiatry. 1997;38(5):581-6.
Idris IB, Barlow J, Dolan A, Surat S. The reliability and validity of the Malay parent-report version of the strengths and difficulties questionnaire. Malays J Med Sci. 2019;26(1):125-37.
Kuniyoshi Y, Kikuya M, Miyashita M, Yamanaka C, Ishikuro M, Obara T, et al. Severity of eczema and mental health problems in Japanese schoolchildren: the ToMMo child health study. Allergol Int. 2018;67(4):481-6.
Matsuishi T, Nagano M, Araki Y, Tanaka Y, Iwasaki M, Yamashita Y, et al. Scale properties of the Japanese version of the strengths and difficulties questionnaire (SDQ): a study of infant and school children in community samples. Brain Dev. 2008;30(6):410-5.
Romanos M, Gerlach M, Warnke A, Schmitt J. Association of attention-deficit/hyperactivity disorder and atopic eczema modified by sleep disturbance in a large population-based sample. J Epidemiol Community Health. 2010;64(3):269-73.
Prion S, Haerling KA. Making sense of methods and measurement: spearman-rho ranked-order correlation coefficient. Clin Simul Nurs. 2014;10(10):535-6.
Kantor R, Silverberg JI. Environmental risk factors and their role in the management of atopic dermatitis. Expert Rev Clin Immunol. 2017;13(1):15-26.
Engebretsen KA, Johansen JD, Kezic S, Linneberg A, Thyssen JP. The effect of environmental humidity and temperature on skin barrier function and dermatitis. J Eur Acad Dermatol Venereol. 2016;30(2):223-49.
Langan SM, Silcocks P, Williams HC. What causes flares of eczema in children? Br J Dermatol. 2009;161(3):640-6.
Wollenberg A, Christen-Zach S, Taieb A, Paul C, Thyssen JP, de Bruin-Weller M, et al. ETFAD/EADV eczema task force 2020 position paper on diagnosis and treatment of atopic dermatitis in adults and children. J Eur Acad Dermatol Venereol. 2020;34(12):2717-44.
Kong TS, Han TY, Lee JH, Son SJ. Correlation between severity of atopic dermatitis and sleep quality in children and adults. Ann Dermatol. 2016;28(3):321-6.
Lycett K, Mensah FK, Hiscock H, Sciberras E. A prospective study of sleep problems in children with ADHD. Sleep Med. 2014;15(11):1354-61.
Ogundele MO. Behavioural and emotional disorders in childhood: a brief overview for paediatricians. World J Clin Pediatr. 2018;7(1):9-26.