Nocturnal Scratching and Quality of Sleep in Children with Atopic Dermatitis

Authors

  • Akiko Sugiyama Department of Allergology and Dermatology, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan
  • Yoko Murakami Department of Pediatrics, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan
  • Kazuaki Okamoto Maruho Co. Ltd. Osaka, Japan
  • Hiroshi Nakano Sleep Disorders Center, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan
  • Masatoshi Wakatsuki Department of Pediatrics, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan
  • Toshiaki Kawano Department of Pediatrics, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan Sleep Disorders Center, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan
  • Yuko Akamine Department of Pediatrics, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan
  • Mihoko Iwata Department of Pediatrics, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan Sleep Disorders Center, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan
  • Chikako Motomura Department of Pediatrics, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan Sleep Disorders Center, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan
  • Kaoru Kojima Department of Clinical Research, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan
  • Makiko Oda Department of Clinical Research, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan
  • Satoshi Honjo Department of Pediatrics, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan, Department of Clinical Research, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan
  • Hiroshi Odajima Department of Pediatrics, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan
  • Takeshi Nakahara Department of Dermatology, Kyushu University, Fukuoka, Japan
  • Masutaka Furue Department of Dermatology, Kyushu University, Fukuoka, Japan
  • Akihiko Ikoma Maruho Co. Ltd. Osaka, Japan

DOI:

https://doi.org/10.2340/actadv.v103.12345

Keywords:

atopic dermatiti, itching, Itch Tracker, pediatric patients, polysomnography, scratching

Abstract

Itching due to atopic dermatitis causes sleep disorders in children, but its pathology is unknown. The aim of this study is to investigate nocturnal scratching as an indirect index of itching during sleep and its relationship with depth of sleep in children with atopic dermatitis. Nocturnal scratching was measured in a total of 20 children with atopic dermatitis, using a smartwatch installed with the application Itch Tracker. Depth of sleep was analysed using polysomnography. The severity of atopic dermatitis was scored using Eczema Area and Severity Index (EASI) and Patient-Oriented Eczema Measure (POEM). The number and time of nocturnal scratching measured by Itch Tracker had a significantly positive correlation with EASI scores, whereas POEM scores were not correlated with EASI scores. Mean sleep efficiency was 90.0% and scratching episodes (n = 67) started mainly during the awake stage or light sleep stages. In the scratching episodes that started during sleep stages (n = 34), the sleep stage changed to a lighter one or to the awake stage in 35.5% of episodes. Itch Tracker is applicable to measure nocturnal scratching in children. Nocturnal scratching can deteriorate quality of sleep by changing the sleep stage to a lighter one or to the awake stage.

Downloads

Download data is not yet available.

References

Fishbein AB, Vitaterna O, Haugh IM, Bavishi AA, Zee PC, Turek FW, et al. Nocturnal eczema: review of sleep and circadian rhythms in children with atopic dermatitis and future research directions. J Allergy Clin Immunol 2015; 136: 1170-1177.

https://doi.org/10.1016/j.jaci.2015.08.028 DOI: https://doi.org/10.1016/j.jaci.2015.08.028

Thorburn PT, Renata L Riha. Skin disorders and sleep in adults: where is the evidence? Sleep Med Rev 2010; 14: 351-358.

https://doi.org/10.1016/j.smrv.2009.12.001 DOI: https://doi.org/10.1016/j.smrv.2009.12.001

Ebata T, Aizawa H, Kamide R, Niimura M. The characteristics of nocturnal scratching in adults with atopic dermatitis. Br J Dermatol 1999; 141: 82-86.

https://doi.org/10.1046/j.1365-2133.1999.02924.x DOI: https://doi.org/10.1046/j.1365-2133.1999.02924.x

Yano C, Saeki H, Ishiji T, Ishiuji Y, Sato J, Tofuku Y, et al. Impact of disease severity on sleep quality in Japanese patients with atopic dermatitis. J Dermatol Sci 2013; 72: 195-197.

https://doi.org/10.1016/j.jdermsci.2013.06.010 DOI: https://doi.org/10.1016/j.jdermsci.2013.06.010

Li JC, Fishbein A, Singam V, Patel KR, Zee PC, Attarian H, et al. Sleep disturbance and sleep-related impairment in adults with atopic dermatitis: a cross-sectional study. Dermatitis 2018; 29: 270-277.

https://doi.org/10.1097/DER.0000000000000401 DOI: https://doi.org/10.1097/DER.0000000000000401

Arima K, Gupta S, Gadkari A, Hiragun T, Kono T, Katayama I, et al. Burden of atopic dermatitis in Japanese adults: analysis of data from the 2013 National Health and Wellness Survey. J Dermatol 2018; 45: 390-396.

https://doi.org/10.1111/1346-8138.14218 DOI: https://doi.org/10.1111/1346-8138.14218

Schmitt J, Romanos M, Schmitt NM, Meurer M, Kirch W. Atopic eczema and attention-deficit/hyperactivity disorder in a population-based sample of children and adolescents. JAMA 2009; 301: 724-726.

https://doi.org/10.1001/jama.2009.136 DOI: https://doi.org/10.1001/jama.2009.136

Strom MA, Fishbein AB, Paller AS, Silverberg JI. Association between atopic dermatitis and attention deficit hyperactivity disorder in U.S. children and adults. Br J Dermatol 2016; 175: 920-929.

https://doi.org/10.1111/bjd.14697 DOI: https://doi.org/10.1111/bjd.14697

Horev A, Freud T, Manor I, Cohen AD, Zvulunov A. Risk of attention-deficit/hyperactivity disorder in children with atopic dermatitis. Acta Dermatovenerol Croat 2017; 25: 210-214.

Romanos M, Gerlach M, Warnke A, Schmitt J. Assotiation of attention-deficit/hyperactivity disorder and atopic eczema modified by sleep disturbance in a large population-based sample. J Epidemiol Community Health 2010; 64: 269-273.

https://doi.org/10.1136/jech.2009.093534 DOI: https://doi.org/10.1136/jech.2009.093534

Ebata T. Measurement of itch: actigraphy. In: Misery L, Staender S, editors. Pruritus. Second edition. Springer-Verlag, London, UK; 2016: p. 97-101.

https://doi.org/10.1007/978-3-319-33142-3_13 DOI: https://doi.org/10.1007/978-3-319-33142-3_13

Ikoma A, Ebata T, Chantalat L, Takemura K, Mizzi F, Poncet M, et al. Measurement of nocturnal scratching in patients with pruritus using a smartwatch: initial clinical studies with the Itch Tracker App. Acta Derm Venereol 2019; 99: 268-273.

https://doi.org/10.2340/00015555-3105 DOI: https://doi.org/10.2340/00015555-3105

Bender BG, Leung SB, Leung DY. Actigraphy assessment of sleep disturbance in patients with atopic dermatitis: an objective life quality measure. J Allergy Clin Immunol 2003; 111: 598-602.

https://doi.org/10.1067/mai.2003.174 DOI: https://doi.org/10.1067/mai.2003.174

Sandoval LF, Huang K, O'Neill JL, Gustafson CJ, Hix E, Harrison J, et al. Measure of atopic dermatitis disease severity using actigraphy. J Cutan Med Surg 2014; 18: 49-55.

https://doi.org/10.2310/7750.2013.13093 DOI: https://doi.org/10.2310/7750.2013.13093

Gustafson CJ, O'Neill J, Hix E, McLaren DT, Buxton OM, Feldman SR. Feasibility of actigraphy wristband monitoring of atopic dermatitis in children. Skin Res Technol 2014; 20: 510-514.

https://doi.org/10.1111/srt.12147 DOI: https://doi.org/10.1111/srt.12147

Ebata T, Iwasaki S, Kamide R, Niimura M. Use of a wrist activity monitor for the measurement of nocturnal scratching in patients with atopic dermatitis. Br J Dermatol 2001; 144: 305-309.

https://doi.org/10.1046/j.1365-2133.2001.04019.x DOI: https://doi.org/10.1046/j.1365-2133.2001.04019.x

Fujita H, Nagashima M, Takeshita Y, Aihara M. Correlation between nocturnal scratch behavior assessed by actigraphy and subjective/objective parameters in patients with atopic dermatitis. Eur J Dermatol 2014; 24: 120-122.

https://doi.org/10.1684/ejd.2013.2242 DOI: https://doi.org/10.1684/ejd.2013.2242

Kolla BP, Mansukhani S, Mansukhani MP. Consumer sleep tracking devices: a review of mechanisms, validity and utility. Expert Rev Med Devices 2016; 13: 497-506.

https://doi.org/10.1586/17434440.2016.1171708 DOI: https://doi.org/10.1586/17434440.2016.1171708

Berry RB, Brooks R, Gamaldo CE, Harding SM, Lloyd RM, Marcus CL, at et al. American Academy of Sleep Medicine. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, version 2.3. www.aasmnet.org. Darien, IL: American Academy of Sleep Medicine, 2016.

Charman CR, Venn AJ, Williams HC. The patient-oriented eczema measure: development and initial validation of a new tool for measuring atopic eczema severity from the patients' perspective. Arch Dermatol 2004; 140: 1513-1519.

https://doi.org/10.1001/archderm.140.12.1513 DOI: https://doi.org/10.1001/archderm.140.12.1513

Charman CR, Venn AJ, Ravenscroft JC, Williams HC. Translating Patient-Oriented Eczema Measure (POEM) scores into clinical practice by suggesting severity strata derived using anchor-based methods. Br J Dermatol 2013; 169: 1326-1332.

https://doi.org/10.1111/bjd.12590 DOI: https://doi.org/10.1111/bjd.12590

Spuls PI, Gerbens LAA, Simpson E, Apfelbacher CJ, Chalmers JR, Thomas KS, et al. Patient-Oriented Eczema Measure (POEM), a core instrument to measure symptoms in clinical trials: a Harmonising Outcome Measures for Eczema (HOME) statement. Br J Dermatol 2017; 17: 979-984.

https://doi.org/10.1111/bjd.15179 DOI: https://doi.org/10.1111/bjd.15179

Schram ME, Spuls PI, Leeflang MM, Lindeboom R, Bos JD, Schmitt J. Share. EASI, (objective) SCORAD and POEM for atopic eczema: responsiveness and minimal clinically important difference. Allergy 2012; 67: 99-106.

https://doi.org/10.1111/j.1398-9995.2011.02719.x DOI: https://doi.org/10.1111/j.1398-9995.2011.02719.x

Patel T, Ishiuji Y, Yosipovitch G. Nocturnal itch: why do we itch at night? Acta Derm Venereol 2007; 87: 295-298.

https://doi.org/10.2340/00015555-0280 DOI: https://doi.org/10.2340/00015555-0280

Ridd MJ, Gaunt DM, Guy RH, Redmond NM, Garfield K, Hollinghurst S, et al. Comparison of patient (POEM), observer (EASI, SASSAD, TIS) and corneometry measures of emollient effectiveness in children with eczema: findings from the COMET feasibility trial. Br J Dermatol 2018; 179: 362-370.

https://doi.org/10.1111/bjd.16475 DOI: https://doi.org/10.1111/bjd.16475

Kido-Nakahara M, Nakahara T, Yasukochi Y, Ulzii D, Furue M. Patient-Oriented Eczema Measure score: a useful tool for web-based surveys in patients with atopic. Acta Derm Venereol 2020; 100: adv00159.

https://doi.org/10.2340/00015555-3530 DOI: https://doi.org/10.2340/00015555-3530

Chang YS, Chou YT, Lee JH, Dai YS, Sun C, Lin YT, et al. Atopic dermatitis, melatonin, and sleep disturbance. Pediatrics 2014; 134: e397-405.

https://doi.org/10.1542/peds.2014-0376 DOI: https://doi.org/10.1542/peds.2014-0376

Reuveni H, Chapnick G, Tal A, Tarasiuk A. Sleep fragmentation in children with atopic dermatitis. Arch Pediatr Adolesc Med 1999; 153: 249-253.

https://doi.org/10.1001/archpedi.153.3.249 DOI: https://doi.org/10.1001/archpedi.153.3.249

Gillow G, Jackson K, Mukherji J, Buranosky B, Palomo R, Sheldon S, et al. Timing of scratch and limb movements during sleep in children with atopic dermatitis. Pediatr Dermatol 2023; 40: 305-307.

https://doi.org/10.1111/pde.15212 DOI: https://doi.org/10.1111/pde.15212

Aoki T, Kushimoto H, Hishikawa Y, Savin JA. Nocturnal scratching and its relationship to the disturbed sleep of itchy subjects. Clin Exp Dermatol 1991; 16: 268-272.

https://doi.org/10.1111/j.1365-2230.1991.tb00372.x DOI: https://doi.org/10.1111/j.1365-2230.1991.tb00372.x

Downloads

Published

2023-10-23

How to Cite

Sugiyama, A. ., Murakami, Y., Okamoto, K. ., Nakano, H. ., Wakatsuki, M. ., Kawano, T. ., Akamine, Y. ., Iwata, M. ., Motomura, C. ., Kojima, K. ., Oda, M. ., Honjo, S. ., Odajima, H. ., Nakahara, T. ., Furue, M. ., & Ikoma, A. . (2023). Nocturnal Scratching and Quality of Sleep in Children with Atopic Dermatitis. Acta Dermato-Venereologica, 103, adv12345. https://doi.org/10.2340/actadv.v103.12345

Issue

Vol. 103 (2023)

Section

Articles

Categories

License

Copyright (c) 2023 Akiko Sugiyama, Yoko Murakami, Kazuaki Okamoto, Hiroshi Nakano, Masatoshi Wakatsuki, Toshiaki Kawano, Yuko Akamine, Mihoko Iwata, Chikako Motomura, Kaoru Kojima, Makiko Oda, Satoshi Honjo, Hiroshi Odajima, Takeshi Nakahara, Masutaka Furue, Akihiko Ikoma

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

All digitalized ActaDV contents is available freely online. The Society for Publication of Acta Dermato-Venereologica owns the copyright for all material published until volume 88 (2008) and as from volume 89 (2009) the journal has been published fully Open Access, meaning the authors retain copyright to their work.

Unless otherwise specified, all Open Access articles are published under CC-BY-NC licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.

Crossref
Scopus
Google Scholar
Europe PMC