Eczema, Sleep, and Behavior in Children

Eczema is a recurring, primarily non-infectious, inflammatory skin condition present in 10% to 20% of children in industrialized countries.1–8 Sleep disturbance is a common complaint in children with eczema, affecting up to 83% of children during eczema exacerbations.9–14 Sleep in children with eczema has been reported to be characterized by poor initiation,13,15,16 frequent awakenings,15,17–21 and prolonged nocturnal wakefulness.22 Poor sleep is known to be associated with a range of daytime deficits in healthy children.23–27 Behavioral problems have also been reported in children with eczema, including reduced child and family quality of life,14,16,28–33 increased discipline problems,15 and attention deficit hyperactivity disorder (ADHD).34,35 These findings raise the possibility that disturbed sleep caused by eczema may mediate the effect of eczema on daytime behavior.36,37 It is noteworthy that this relationship is complicated by the frequent co-occurrence of asthma and rhinitis in children with eczema.38 These atopies are also known to adversely impact sleep39,40 and are associated with behavioral deficits.41,42 In children with eczema, the relative contributions of eczema, rhinitis, and asthma to sleep disturbance and deficits in daytime behavior have yet to be examined. The aim of the present study was to investigate the frequency of sleep problems in children with eczema compared to healthy controls and, after controlling for asthma and rhinitis, to evaluate its independent association with daytime behavior and quality of life. BRIEF SUMMARY Current Knowledge/Study Rationale: Eczema is known to adversely affect daytime behavior. It is unclear whether this is a direct effect or mediated by the effect of eczema on sleep quality. Study Impact: This study demonstrates that the effect of eczema on daytime behavior is mediated by its effect on sleep quality. This highlights the importance of the recognition and management of sleep problems in children with eczema.