Introduction
Atopic dermatitis (AD) has a significant impact on quality of life, particularly related to sleep disorders secondary to pruritus. The aim of this study was to assess the sleep of patients with AD and compare it to that of healthy volunteers (SV) using a wrist activity monitor and a smartphone app.
Material and methods
32 patients with moderate to severe AD (EASI score ≥ 7.1 – IGA ≥ 3 and BSA ≥ 10) and 20 SV were included. Sleep data was recorded for 14 days (Actisleep smartphone app, morning and evening) and 14 nights (non-dominant wrist actimetry, Motionwatch8, CamNtech, Cambridge, UK.) The parameters analyzed were total sleep time, the time spent in bed, the total duration of awake periods after falling asleep, the sleep efficiency index, the number and duration of awakenings, and the nocturnal fragmentation index. The severity of the disease was assessed at the start of the study and the intensity of the pruritus daily.
Results
78% of patients and SV used the application (70% for the actimeter) and had actionable data (≥ 5 consecutive recording nights and 2 weekend days for both devices). The mean age of patients and SV was 31 years ± 12 and 34 years ± 9, respectively. The female / male ratio in patients was 1.6 and 2.3 in SV (not significant). Total sleep time was lower in patients: 5.9 hours ± 1.5 versus 6.6 hours ± 0.6 (p = 0.02). The number of patient awakenings after falling asleep was higher: 1.3 ± 0.9 versus 0.5 ± 0.4 (p = 0.002). They had a lower sleep efficiency index: 73.2% vs. 86% (p = 0.0018) and had a higher fragmentation index: 43 vs. 25.6 (p = 0.004). The DLQI objectified an alteration in the quality of life of patients compared to SV. The data collected by the smartphone was strongly correlated with that of actimetry: time of going to bed (r = 0.85), of falling asleep (r = 0.83), of waking up (r = 0.92), of getting up (r = 0.92), total sleep time (r = 0.65) and time spent in bed (r = 0.94).
Discussion
This pilot study demonstrates, by actigraphy and self-report sleep measurements, separately and / or in combination, that patients with moderate to severe AD have significantly more disturbed sleep than SV, qualitatively and quantitatively. The smartphone e-quiz is a simple, non-invasive method to explore the quality and quantity of sleep, while actigraphy helps to collect more objective data. Larger cohort studies are warranted to confirm these data. These tools could also be of interest to assess the clinical efficacy of drugs in patients with AD.