title: Burden of Sleep and Fatigue in US Adults With Atopic Dermatitis.
abstract: BACKGROUND
  Intense itch associated with atopic dermatitis (AD) can negatively impact sleep. However, the nature of sleep disturbance and fatigue in AD has not been fully elucidated.
  
  
  OBJECTIVE
  The aim of this study was to determine the burden of sleep disturbance and fatigue in US adults with AD.
  
  
  METHODS
  This study used a cross-sectional, questionnaire-based survey using a nationally representative sample of 5563 adults from the 2005 to 2006 National Health and Nutrition Examination Survey. Respondents were asked about history of AD, sleep disturbance, and fatigue-related instrumental activity of daily living (IADL) impairment.
  
  
  RESULTS
  There was no significant association between having AD and having a diagnosed sleep disorder (10.44% vs 7.27%; odds ratio [OR] [95% confidence interval (CI)], 1.49 [0.84-2.64]; P = 0.23); however, respondents were more likely to report sleep disturbances to clinicians (33.38% vs 23.67%; OR [95% CI], 1.62 [1.10-2.38]; P = 0.04). In multivariate regression models controlling for sociodemographic and lifestyle factors, adults with AD had higher odds of sleep disturbances, including shorter sleep duration (adjusted OR [95% CI], 1.61 [1.16-2.25]), trouble falling asleep (adjusted OR [95% CI], 1.57 [1.10-2.24]), and early morning awakenings (adjusted OR [95% CI], 1.86 [1.24-22.78]). Those with AD also had significantly higher odds of feeling unrested and feeling too tired to perform IADLs.
  
  
  CONCLUSIONS
  United States adults with AD have significantly impaired sleep and fatigue affecting IADLs, and sleep disturbances may be underdiagnosed in this population.
authors.affiliation: From the *Department of Dermatology, Case Western Reserve University, Cleveland, OH; and †Center for Circadian and Sleep Medicine, Feinberg School of Medicine, Northwestern University; ‡Departments of Dermatology, Preventive Medicine, and Medical Social Sciences, Feinberg School of Medicine at Northwestern University; and §Northwestern Medicine Multidisciplinary Eczema Center, Chicago, IL.
authors.forename: Sherry H
authors.initials: SH
authors.lastname: Yu
authors.forename: Hrayr
authors.initials: H
authors.lastname: Attarian
authors.forename: Phyllis
authors.initials: P
authors.lastname: Zee
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Silverberg
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D003876:Dermatitis, Atopic / Q000453:epidemiology*; D005221:Fatigue / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D016017:Odds Ratio; D011537:Pruritus / Q000453:epidemiology*; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology*; D012893:Sleep Wake Disorders / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D055815:Young Adult