Atopic Dermatitis, Melatonin, and Sleep Disturbance
Atopic Dermatitis, Melatonin, and Sleep Disturbance
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DOI：
10.1542/peds.2014-0376
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发表时间：
2014-08-01
期刊：
影响因子：
8
通讯作者：
Chiang, Bor-Luen
中科院分区：
文献类型：
--
作者：
Chang, Yung-Sen;Chou, Yen-Ting;Chiang, Bor-Luen
背景和目的：睡眠障碍在特应性皮炎（AD）患者中很常见。然而，研究主要是基于问卷调查的，病理生理学仍不清楚。本研究的目的是确定 AD 儿童睡眠障碍的客观特征，并探讨影响因素和临床预测因素。方法：通过体动记录仪和多导睡眠图测量 72 名 AD 患者和 32 名年龄为 1 至 18 岁的对照者的睡眠参数。还测量了尿 6-磺酰氧基褪黑激素水平、血清细胞因子以及总和过敏原特异性免疫球蛋白 E (IgE) 水平。 结果：AD 患者的睡眠效率显着降低、入睡潜伏期更长、睡眠碎片更多、非快速动眼睡眠更少。体动记录仪的结果与多导睡眠图的结果有很好的相关性。 AD 疾病的严重程度与睡眠障碍相关 (r = 0.55-0.7)，特应性皮炎评分指数 >= 48.7 预测睡眠效率不佳，敏感性为 83.3%，特异性为 75%（曲线下面积 = 0.81，P = .001）。 AD 患者夜间褪黑激素分泌减少与睡眠障碍显着相关。睡眠障碍的其他相关因素包括瘙痒、抓挠、较高的血清总 IgE 水平以及对尘螨和葡萄球菌肠毒素的过敏。 结论：睡眠效率差在 AD 儿童中很常见，可以通过特应性皮炎评分指数进行预测。褪黑激素和 IgE 可能在睡眠障碍中发挥作用。需要进一步的研究来探索其机制和临床意义，体动记录仪可以作为一种有用的评估工具。
BACKGROUND AND OBJECTIVES: 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.