Atopic Dermatitis Tied to Sleep Disturbances in Children

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Improved Sleep may be an Important Treatment Focus

Atopic dermatitis (AD), or eczema, can cause more problems than just chronically red, itchy skin. According to the August issue of the AMA's Archives of Pediatrics and Adolescent Medicine, children with AD are often plagued with sleep-related problems than can affect the entire family.

Ronald E. Dahl, M.D, from the University of Pittsburgh School of Medicine in Pennsylvania, and colleagues compared the sleep habits and behaviors of 59 children between the ages of 5-12 years, who met the criteria for AD, with 675 children without AD. The AD sample includes children from a wide region of the United States and Canada. The comparison was made from answers to a questionnaire filled out by the parents.

The researchers found that: "Children with AD had more restless sleep, frequent waking during the night, sitting up in bed, difficulty falling asleep, fear of the dark, difficulty waking up in the morning, frequent waking to go to the bathroom, frequent complaints (by the child) about difficulty falling asleep, and fewer hours of sleep than normal values."

The study showed that these sleep disturbances were intensified by the severity of the AD and translated into trouble staying awake in the afternoon, disruption of family activities because of irritability or aggressive behaviors and major disciplinary problems.

While the child's itching and scratching is a logical explanation for the sleep disturbances, the researchers also found that children who were in good medical control of their illness were also having notable sleep problems. They write: "These findings are consistent with the idea that learned and behavioral factors may sometimes perpetuate sleep problems even after symptoms of AD are under control."

The authors continue: "From a clinical perspective, it seems that many children with AD are getting insufficient (or marginal) sleep. One implication is the importance of avoiding additional sources of sleep loss or sleep disturbances. Specifically prudent recommendations for families with children with AD would include the importance of good sleep habits, regular sleep and wake schedules, avoidance of caffeinated beverages, and limiting procrastination of bedtime. Morning routines and schedules should be organized to permit as much sleep as possible. Pharmacologic therapy also could be considered, but in general, medications to improve sleep onset and sleep continuity have not shown long-term efficacy in children. Tolerance effects, withdrawal effects, and occasional paradoxical effects in the arousal system are potential difficulties resulting from the use of hypnotics and sedatives to treat chronic sleep problems."

They conclude: "The study raises many questions, especially the issue of the long-term consequences from chronic sleep disruption and inadequate sleep. The possibility of important long-term behavioral and emotional and physiologic changes resulting from chronic sleep disturbance in this population deserves further investigation."

The AMA's Encyclopedia of Medicine says AD is common in babies and usually appears between the ages of 2-18 months. It occurs in people who have an inherited tendency toward allergy. They, or members of their family may also have other allergies, such as asthma or allergic rhinitis. AD often clears of its own accord as the child grows older, although it may come and go for several years before disappearing. Most children outgrow the condition by the time they reach puberty.

Source: American Medical Association
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