Sleep disturbance in adult dermatologic patients: A cross-sectional study on prevalence, burden, and associated factors

Abstract

Background: Sleep disturbance remains insufficiently characterized in many dermatoses.

Objective: To investigate the prevalence, burden, and factors associated with sleep disturbance in dermatologic patients.

Methods: We recruited 800 patients and recorded pruritus characteristics and sociodemographic and clinical parameters. Validated questionnaires were used to assess sleep disturbance, psychological distress, health-related quality of life, and work productivity.

Results: Two thirds of patients met criteria of poor sleep, which was associated with psychological distress, diminished health-related quality of life, and lost work productivity. Patients with average and maximum pruritus on the visual analog scale exceeding 5 and 6.5 points, respectively, were at high risk of suffering pruritus-related sleep disturbance. Overall pruritus intensity and its nocturnal exacerbation contributed independently to sleep disturbance. Psychological distress was of even higher impact on sleep than pruritus and almost a third of the relationship between pruritus intensity and sleep was mediated by psychological distress.

Conclusion: Sleep disturbance is prevalent in dermatologic patients and constitutes a considerable burden.

Clinical implication: Dermatologic patients with intense pruritus and psychological distress should be examined for sleep disorders. Adequate antipruritic therapy and complementary psychotherapy in affected patients may help them regain restorative sleep.

Keywords: activity; anxiety; depression; pruritus; psychological distress; quality of life; sleep quality; work productivity.