From the dermatology foundationSleep disturbance in adults with chronic pruritic dermatoses is associated with increased C-reactive protein levels
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)
- et al.
The relationship between sleep apnea, metabolic dysfunction and inflammation: the gender influence
Brain Behav Immun
(2017) - et al.
Emerging biomarkers and therapeutic pipelines for chronic spontaneous urticaria
J Allergy Clin Immunol Pract
(2018) - et al.
What does minor elevation of C-reactive protein signify?
Am J Med
(2006) - et al.
Effect of sleep loss on C-reactive protein, an inflammatory marker of cardiovascular risk
J Am Coll Cardiol
(2004) - et al.
Itching at night: a review on reducing nocturnal pruritus in children
Pediatr Dermatol
(2018) - et al.
Insomnia and other sleep complaints in inflammatory versus noninflammatory skin disorders: an observational case-control study
Int J Dermatol
(2019) - et al.
A cross-sectional survey of the nature and correlates of sleep disturbance in people with psoriasis
Br J Dermatol
(2017) - et al.
Factors influencing sleep difficulty and sleep quantity in the Citizen Pscientist Psoriatic Cohort
Dermatol Ther (Heidelb)
(2019) - et al.
Burden of sleep and fatigue in US adults with atopic dermatitis
Dermatitis
(2016)
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Cross talk mechanism of disturbed sleep patterns in neurological and psychological disorders
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2022, PsychoneuroendocrinologyCitation Excerpt :Serum CRP remains the gold standard of measurement for CRP. Serum CRP has been positively associated with a higher risk of cardiovascular diseases (Ridker, 2003), stroke (Kuo et al., 2005) and sleep disturbance in healthy samples (Huang et al., 2017; McDade et al., 2006) and clinical samples (Patel et al., 2021; Wilson et al., 2015). Though a longitudinal study (Copeland et al., 2012) did not find serum CRP to predict later anxiety symptoms in adolescents, elevated serum CRP levels have in general been linked with depression in healthy adults (Kohler-Forsberg et al., 2017; Osimo et al., 2020; Suarez et al., 2015), anxiety symptoms in adolescents (Khandaker et al., 2016), and lower positive affect in community-dwelling adults (Ironson et al., 2018; Steptoe et al., 2007).
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2022, Journal of the American Academy of DermatologyCitation Excerpt :A contributing factor may be the increased odds of malaise/fatigue observed in patients with AD compared to controls or the increased odds of sleep disorders. Previous reports found that sleep disorders in AD were associated with overall work absenteeism and impairment8,27 and a negative impact on overall well-being.11,28-31 Together, our results provide further support that AD is associated with a profound psychological burden on adult patients, which may impact their work productivity and social functioning in a broader context.8
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2022, Journal of the American Academy of DermatologyCitation Excerpt :Itch severity correlates with the level of depressive symptoms.115 Because of its detrimental effects on sleep and quality of life,116,117 chronic pruritus leads to increased psychiatric burden of disease118 and higher odds of suicidal ideation.11 Itch also is often reported in patients with primary psychodermatologic conditions, including somatic symptom disorder, dermatitis artefacta, obsessive-compulsive disorder, delusional infestation, excoriation disorder, and Morgellons disease.
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2022, Journal of Investigative DermatologyCitation Excerpt :Furthermore, itch sensation also impairs sleep quality (Hawro et al., 2021); a study of 126 patients with inflammatory skin diseases found that 69.8% of patients suffered from itch-related sleep disturbance (Chee et al., 2020). Another analysis found chronic pruritic dermatoses to be associated with increased nighttime awakenings (Patel et al., 2021). In parallel, patients with chronic pruritus suffer from substantial economic burden.
Nocturnal pruritus and sleep disturbance associated with dermatologic disorders in adult patients
2021, International Journal of Women's DermatologyCitation Excerpt :AD and rosacea were the most common associated skin disorders in the study. Systemic inflammation has been suggested as a possible link between chronic pruritic dermatoses and SD because an increased serum C-reactive protein level was documented in patients with SD (Patel et al., 2021). There is a scarcity of controlled data on NP therapy.
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.