title: Atopic dermatitis, melatonin, and sleep disturbance.
abstract: OBJECTIVE
  Sleep disturbance is common in patients with atopic dermatitis (AD). However, studies have largely been questionnaire-based, and the pathophysiology remains unclear. The aims of this study were to determine objective characteristics of sleep disturbance in children with AD and explore contributing factors and clinical predictors.
  
  
  METHODS
  Sleep parameters were measured by actigraphy and polysomnography in 72 patients with AD and 32 controls ages 1 to 18 years. Urinary 6-sulfatoxymelatonin levels, serum cytokines, and total and allergen-specific immunoglobulin E (IgE) levels were also measured.
  
  
  RESULTS
  The patients with AD had significantly reduced sleep efficiency, longer sleep onset latency, more sleep fragmentation, and less nonrapid eye movement sleep. Results from actigraphy correlated well with those from polysomnography. The AD disease severity was associated with sleep disturbance (r = 0.55-0.7), and a Scoring Atopic Dermatitis index of ≥48.7 predicted poor sleep efficiency with a sensitivity of 83.3% and a specificity of 75% (area under the curve = 0.81, P = .001). Lower nocturnal melatonin secretion was significantly associated with sleep disturbance in the patients with AD. Other correlates of sleep disturbance included pruritus, scratching movements, higher total serum IgE levels, and allergic sensitization to dust mite and staphylococcal enterotoxins.
  
  
  CONCLUSIONS
  Poor sleep efficiency is common in children with AD and can be predicted by the Scoring Atopic Dermatitis index. Melatonin and IgE might play a role in the sleep disturbance. Further studies are required to explore the mechanisms and clinical implications, and actigraphy could serve as a useful evaluating tool.
authors.affiliation: Department of Pediatrics, Taipei City Hospital Renai Branch, Taipei City, Taiwan;
authors.forename: Yung-Sen
authors.initials: YS
authors.lastname: Chang
authors.affiliation: Department of Pediatrics, Cardinal Tien Hospital Yonghe Branch, New Taipei City, Taiwan;
authors.forename: Yen-Ting
authors.initials: YT
authors.lastname: Chou
authors.affiliation: Departments of Pediatrics.
authors.forename: Jyh-Hong
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Internal Medicine.
authors.forename: Pei-Lin
authors.initials: PL
authors.lastname: Lee
authors.affiliation: Dermatology, and.
authors.forename: Yang-Shia
authors.initials: YS
authors.lastname: Dai
authors.affiliation: Departments of Pediatrics.
authors.forename: Chi
authors.initials: C
authors.lastname: Sun
authors.affiliation: Departments of Pediatrics.
authors.forename: Yu-Tsan
authors.initials: YT
authors.lastname: Lin
authors.affiliation: Departments of Pediatrics.
authors.forename: Li-Chieh
authors.initials: LC
authors.lastname: Wang
authors.affiliation: Departments of Pediatrics.
authors.forename: Hsin-Hui
authors.initials: HH
authors.lastname: Yu
authors.affiliation: Departments of Pediatrics.
authors.forename: Yao-Hsu
authors.initials: YH
authors.lastname: Yang
authors.affiliation: Departments of Pediatrics.
authors.forename: Chun-An
authors.initials: CA
authors.lastname: Chen
authors.affiliation: Department of Pediatrics, Taipei City Hospital Renai Branch, Taipei City, Taiwan;
authors.forename: Kong-Sang
authors.initials: KS
authors.lastname: Wan
authors.affiliation: Departments of Pediatrics,Graduate Institute of Immunology, College of Medicine, National Taiwan University, Taipei, TaiwanMedical Research, National Taiwan University Hospital, Taipei City, Taiwan; and gicmbor@ntu.edu.tw.
authors.forename: Bor-Luen
authors.initials: BL
authors.lastname: Chiang
mesh_terms: D056044:Actigraphy; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003430:Cross-Sectional Studies; D016207:Cytokines / Q000032:analysis; D003876:Dermatitis, Atopic / Q000453:epidemiology* / Q000378:metabolism; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000032:analysis; D008297:Male; D008550:Melatonin / Q000378:metabolism*; D017286:Polysomnography; D012892:Sleep Deprivation; D012893:Sleep Wake Disorders / Q000453:epidemiology* / Q000378:metabolism
chemical_list: D016207:Cytokines; D007073:Immunoglobulin E; D008550:Melatonin
keywords: IgE; SCORAD; actigraphy; atopic dermatitis; dust mite; melatonin; polysomnography; sleep disturbance; staphylococcal enterotoxin