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Ronald E. Dahl, MD; Jan Bernhisel-Broadbent, MD; Sheila Scanlon-Holdford, RN, MS, PNP; Hugh A. Sampson, MD; Mark Lupo

Arch Pediatr Adolesc Med. 1995;149(8):856-860.

Abstract
Objectives
To test hypotheses based on clinical impressions that children with atopic dermatitis (AD) have frequent sleep-related problems, including difficulty falling asleep, night waking due to itching and scratching, and daytime symptoms of tiredness and irritability.

Design
Sleep habits and behaviors were assessed using the Child Sleep Behavior Scale (a 22-item Likerttype questionnaire for parents) in children with AD compared with normative data for age. Twelve questions were added to the questionnaire to address sleep-related habits relevant to night time pruritus, and to assess daytime behavioral symptoms of inadequate sleep.

Setting
Tertiary care center.

Patients
Fifty-nine children between ages 5 and 12 years meeting criteria for AD representing a referral population to a regional center.

Results
Compared with normative data, children with AD showed notable differences for nine of the 22 items on the sleep questionnaire, including the following: greater difficulty falling asleep, frequent night waking, less total sleep, and greater difficulty awakening for school. The children with AD also reported frequent daytime tiredness and irritability, and the severity of AD symptoms showed moderate correlations with sleep problems and with daytime behaviors suggestive of inadequate sleep. Difficulty falling asleep and night waking correlated with daytime behavior and discipline problems.

Conclusions
Children with AD often have disrupted sleep and daytime behavioral difficulties associated with insufficient sleep. Improved sleep may be an important treatment focus in the clinical management of children with AD.

(Arch Pediatr Adolesc Med. 1995;149:856-860)

Author Affiliations
From the Department of Psychiatry, University of Pittsburgh (Pa) School of Medicine (Dr Dahl and Mr Lupo); and the Division of Allergy and Immunology, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Md (Drs Bernhisel-Broadbent and Sampson and Ms Scanlon-Holdford).

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