title: Eczema, sleep, and behavior in children.
abstract: BACKGROUND
  There is a general consensus that sleep disruption in children causes daytime behavioral deficits. It is unclear if sleep disruption in children with eczema has similar effects particularly after controlling for known comorbid disorders such as asthma and rhinitis.
  
  
  METHODS
  Parents of children (6-16 y) with eczema (n = 77) and healthy controls (n = 30) completed a validated omnibus questionnaire which included the Sleep Disturbance Scale for Children, Conners Parent Rating Scale-Revised (S), Child Health Questionnaire, Children's Dermatology Life Quality Index, and additional items assessing eczema, asthma, rhinitis, and demographics.
  
  
  RESULTS
  Compared to controls, children with eczema had a greater number of sleep problems with a greater percentage in the clinical range, lower quality of life, and higher levels of ADHD and oppositional behavior. They also had elevated rhinitis and asthma severity scores. Importantly, structural equation modelling revealed that the effect of eczema on the behavioral variables of Hyperactivity, ADHD Index, and Oppositional Behaviors were mediated through sleep with no direct effect of eczema on these behaviors. The comorbid atopic disorders of rhinitis and asthma also had independent effects on behavior mediated through their effects on sleep.
  
  
  CONCLUSIONS
  The present findings suggest that the daytime behaviors seen in children with eczema are mediated independently by the effects of eczema, asthma, and rhinitis on sleep quality. These findings highlight the importance of sleep in eczematous children and its role in regulating daytime behavior.
authors.affiliation: Discipline of Paediatrics, School of Paediatrics and Reproductive Health, University of Adelaide, South Australia, Australia.
authors.forename: Danny
authors.initials: D
authors.lastname: Camfferman
authors.forename: J Declan
authors.initials: JD
authors.lastname: Kennedy
authors.forename: Michael
authors.initials: M
authors.lastname: Gold
authors.forename: A James
authors.initials: AJ
authors.lastname: Martin
authors.forename: Peter
authors.initials: P
authors.lastname: Winwood
authors.forename: Kurt
authors.initials: K
authors.lastname: Lushington
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D001249:Asthma / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D016022:Case-Control Studies; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D004485:Eczema / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D011788:Quality of Life; D012016:Reference Values; D012220:Rhinitis / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D018570:Risk Assessment; D017678:Sex Distribution; D012893:Sleep Wake Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D011795:Surveys and Questionnaires