Exploring the interplay of atopic dermatitis severity with sleep and mental health: a case-control study in adult patients

ABSTRACT

Objectives

Atopic dermatitis (AD) is a chronic inflammatory skin disease often associated with non-atopic comorbidities. Recently, a severity-dependent relationship between AD and sleep/mental health diseases has been proposed. However, few studies investigated these comorbidities and their association with AD severity through validated questionnaires. This study aimed to use a set of validated instruments to assess the impact of AD on sleep and psychological disorders and estimate the association of itch and AD severity with sleep disorders and psychological symptoms, distinguishing between clinical-oriented and patient-oriented measures.

Methods

We conducted a case-control study, recruiting 57 adult AD patients (mean age ± std. dev. 34.28 years ± 13.07; 27 males) matched for age and sex with 57 healthy adults (34.39 years ± 13.09; 27 males). To investigate the differences in sleep quality, insomnia, depression, and anxiety between the two groups, we performed independent sample t-Tests. Moreover, we conducted univariate linear regression analyses to examine the relationship between itch and objective/subjective severity of AD and sleep quality, insomnia, and psychological symptoms.

Results

AD patients reported lower sleep quality (p = 0.002), more severe insomnia (p = 0.006) and depression (p = 0.013), and higher stress levels than healthy adults (p = 0.049). Itch intensity was linked to sleep disturbances and psychological symptoms (R²_range = 0.13–0.19, p_range = 0.02–<0.001). Objective and subjective AD severity were similarly associated with worse sleep quality (R² = 0.26, p < 0.001; R² = 0.24, p < 0.001; respectively), anxiety (R² = 0.15, p = 0.04; R² = 0.17, p = 0.001; respectively), and self-perceived stress (R² = 0.10, p = 0.02; R² = 0.07, p = 0.049; respectively). However, subjective AD severity was more strongly associated with insomnia (R² = 0.31, p < 0.001) and depression (R² = 0.20, p < 0.001) than clinical-oriented AD severity (R² = 0.19, p < 0.001; R² = 0.05, p = 0.098; respectively).

Conclusions

The study demonstrated poor sleep quality and high levels of insomnia, depression, and stress in AD patients, with an aggravated psychological status for adults with more severe skin disease. We suggest implementing a multidisciplinary approach to AD management/treatment that considers objective and subjective measures of disease severity.

KEYWORDS:

• Atopic dermatitis severity
• itch
• sleep quality
• insomnia
• depression
• anxiety
• stress

Declaration of financial/other relationships

M Esposito has served as a speaker and board member for AbbVie, Almirall, Biogen, Celgene, Eli Lilly, Janssen, Leo Pharma and Novartis. A Chiricozzi served as an advisory board member and consultant and has received fees and speaker’s honoraria or has participated in clinical trials for AbbVie, Almirall, Leo Pharma, Lilly, Janssen, Novartis, Pfizer and Sanofi Genzyme. K Peris has served on advisory boards and received honoraria for lectures from Almirall, AbbVie, Lilly, Galderma, Leo Pharma, Pfizer, Pierre Fabre, Janssen, Novartis, Sanofi, and Sunpharma. M Concetta Fargnoli has served on advisory boards and received honoraria for lectures and research grants from AMGEN, Almirall, AbbVie, BMS, Galderma, Kyowa Kyrin, Leo Pharma, Pierre Fabre, UCB, Lilly, Pfizer, Janssen, MSD, Novartis, Sanofi-Regeneron and Sunpharma. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

This data has been presented at the 26th Congress of the European Sleep Research Society, Athens (Greece), 2022 and the 32nd National Congress of the Italian Association of Sleep Medicine. Rimini (Italy), 2022.

Author contributions

Maria Esposito: Conceptualization, Methodology, Investigation, Resources; Writing – original draft, Writing – review & editing; Giulia Amicucci: Conceptualization, Methodology, Investigation, Data curation, Formal analysis; Writing – original draft, Writing – review & editing, Visualization; Federico Salfi: Conceptualization, Methodology, Formal analysis; Cristina Pellegrini: Writing – review & editing; Andrea De Berardinis: Writing – review & editing; Andrea Chiricozzi: Writing – review & editing; Ketty Peris: Writing – review & editing; Daniela Tempesta: Writing – review & editing; Michele Ferrara: Conceptualization, Methodology, Writing – review & editing, Supervision; Maria Concetta Fargnoli: Conceptualization, Methodology, Resources, Writing – review & editing, Supervision.

Additional information

Funding

This paper was not funded.