From the dermatology foundation
Sleep disturbance in adults with chronic pruritic dermatoses is associated with increased C-reactive protein levels

https://doi.org/10.1016/j.jaad.2020.08.059Get rights and content

Background

Pruritus is a common symptom that can significantly reduce quality of life through sleep disruption.

Objective

To examine features of disturbed sleep in patients with chronic pruritic dermatoses and test the hypothesis that systemic inflammation may serve as a biomarker for impaired sleep in these patients.

Methods

Cross-sectional analysis of the National Health and Nutrition Examination Survey investigating systemic inflammation using C-reactive protein (CRP) levels. Logistic regression was used to compare patients with and without sleep disturbances, adjusting for demographics (model 1) and medical comorbidities (model 2).

Results

Chronic pruritic dermatoses were associated with multiple sleep disturbances, including nighttime awakenings (model 1: odds ratio [OR], 1.646; 95% confidence interval [CI], 1.031-2.627; model 2: OR, 1.329; 95% CI, 0.888-1.989) and early morning awakening (model 1: OR, 1.669, 95% CI, 1.118-2.493; model 2: OR, 1.582; 95% CI, 1.008-2.481). Mean CRP levels were 52.8% higher among patients with pruritic dermatoses reporting trouble sleeping compared with those who did not (0.663 vs 0.434 mg/dL; P = .034). Trouble sleeping was also positively correlated with CRP levels (β = 0.142, P = .025).

Limitations

Potential recall bias among participants.

Conclusions

In addition to confirming sleep disturbances with pruritic dermatoses, we found these disturbances are more likely to present with elevated CRP levels. Clinicians should consider the potential risk for sleep-related and cardiac comorbidities in patients diagnosed with itchy skin conditions.

Section snippets

Methods

We conducted a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2006, the most recent data set with our study variables.6 The NHANES study was conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention and approved by their institutional review board with written informed consent from all participants. A stratified, randomized, multistage, probability-cluster design was used to select

Results

The NHANES 2005 to 2006 data set included 10,348 participants (Fig 1). Of those, there were 5563 adults. We excluded 1 participant because of incomplete data on the presence of pruritic dermatoses and then excluded 2 additional participants who had no data regarding sleep behavior. Our final analysis included 5560 adults, of whom 498 (8.96%) reported pruritic dermatoses.

Among adults with chronic pruritic dermatoses, the mean age was 48.1 years vs 43.6 years in the control group (P = .0001;

Discussion

Our study demonstrates that adults with chronic pruritic dermatoses are more likely to experience fatigue and sleep disturbances, including trouble falling asleep, early morning awakenings, daytime sleepiness, lack of sleep, frequent nighttime awakening, and leg jerks and cramps while sleeping compared with adults without pruritic dermatoses. Those with itchy skin conditions are also more likely to report difficulty with all activities of daily living secondary to fatigue, even after

Conclusion

Chronic pruritic dermatoses are associated with the diagnosis of a sleep disorder and increased sleep disturbances, which have a significant negative impact on patient activities of daily living secondary to fatigue. This study also reveals that among adults with pruritic dermatoses, those with sleep disturbances are more likely to present with elevated CRP levels. As such, clinicians should consider the potential risk for sleep-related and cardiac comorbidities in patients diagnosed with itchy

References (18)

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Funding sources: None.

Conflicts of interest: Dr Shawn G. Kwatra is on the advisory board for Pfizer Inc, Regeneron Pharmaceuticals, and Menlo Therapeutics, has received grant funding from Pfizer Inc and Kiniksa Pharmaceuticals, and also received a Dermatology Foundation Medical Dermatology Career Development Award. Authors Patel, Khanna, Choi, Williams, Roh, Hong, Sutaria, Pritchard, and Madan M. Kwatra have no conflicts of interest.

IRB approval status: IRB approval was waived, because only an anonymous aggregate-level data count was used, and patient consent was not required.

Reprints not available from the authors.

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