Sleep quality suffers in mothers of children with atopic dermatitis

“In children with [atopic dermatitis], chronically sleep-deprived, exhausted or depressed caregivers may be less equipped to implement time-consuming treatment regimens, regulate their children’s behavior and help the child cope with his or her illness," the authors of the study write. (©Skylines/Shutterstock.com)

Katrina Abuabara, M.D., M.A., M.S.C.E.

Mothers of children with atopic dermatitis are more likely than mothers whose children don’t have the skin condition to report problems sleeping, according to a study published online March 20, 2019 in JAMA Dermatology.¹

U.S. researchers analyzed a cohort of 11,649 mother-child pairs from a town in Southwest England who were followed from birth for an average of 11 years.

“Participants were asked annually about symptoms of atopic dermatitis, including whether disease was active and how severe it was,” said the study’s senior author Katrina E. Abuabara, M.D., M.A., M.S.C.E. The cohort also included data on multiple aspects of maternal sleep including sleep duration, difficulty falling asleep, early morning awakenings, subjectively insufficient sleep and daytime exhaustion.

They found that mothers with and without children with atopic dermatitis had similar reports on sleep duration and early morning awakenings. But mothers with children who had atopic dermatitis were 36% more likely to report difficulty falling asleep; 48% more likely to subjectively say they got insufficient sleep; and 41% more likely to report daytime exhaustion. That was independent of the child’s comorbid asthma and/or allergic rhinitis, according to the study.

Mothers’ sleep duration and sleep quality worsened with children who had more severe disease.

Interestingly, children’s sleep disturbances didn’t fully explain maternal sleep disturbances. The authors point to research that suggests parental or caregiver stress, anxiety, destress and depression associated with caring for children with chronic diseases, including atopic dermatitis, could impact mothers’ sleep quality and duration. 

Mothers’ sleep problems could also impact children with atopic dermatitis, according to the authors.

“Maternal emotional and psychosocial wellbeing is inextricably linked to the child’s health, development and cognitive and social functioning,” the authors write. “In children with [atopic dermatitis], chronically sleep-deprived, exhausted or depressed caregivers may be less equipped to implement time-consuming treatment regimens, regulate their children’s behavior and help the child cope with his or her illness.”

Clinicians caring for children with atopic dermatitis should be aware of the potential for maternal sleep disturbances and fatigue.
“We need additional research to develop recommendations for how dermatologists can best address this issue in clinical practice. The American Academy of Pediatrics recommends that pediatricians assess the health and wellbeing of parents, but the role for specialty providers is less clear. A first step might be to include data on the impact of atopic dermatitis on maternal/caregiver sleep in patient educational materials, to help bring awareness to the issue,” says Dr. Abuabara, who is trained in dermatology, epidemiology, and sociology and is an assistant professor in the department of dermatology at the University of California San Francisco.

The authors provide recommended screening tools for maternal sleep, depression and anxiety for providers who are interested in screening parents. Those are: The Pittsburgh Sleep Quality Index for sleep problems; the Patient Health Questionaire-9 for depression; and the Generalized Anxiety Disorder 7-item Scale for anxiety. 

Meet the InvestigatorKatrina Abuabara, M.D.,Assistant professor, dermatology, University of California, San Francisco

Take me to when you first knew that dermatology was the specialty you wanted to practice:
From a clinical perspective, I loved that dermatology patients could see the progress of their condition even better than I could. For me, this meant that patient care felt more like a partnership rather than a hierarchical relationship in which a physician would hand down lab test results. 

From a research perspective, dermatology seemed like the perfect specialty to study the interplay between genetic and environmental factors. I have degrees in both biology and sociology, and am fascinated by the ways in which our surroundings (both physical and sociocultural) affect our health.

Take me to the moment you knew you wanted to investigate the sleep disturbances of mothers of children with atopic dermatitis:
The National Eczema Association commissioned a burden of disease audit on quality of life and atopic dermatitis. I remember reading the paper by Aaron Drucker and colleagues and feeling amazed that there was a lack of population-based research on sleep and atopic dermatitis. It is well established that sleep has profound impacts on multiple dimensions of health, and that children with severe atopic dermatitis seen in dermatology clinics have poor sleep quality, but there were little data on atopic dermatitis and sleep in the general population. Since atopic dermatitis is so common, but also so heterogeneous in terms of severity and activity, I thought it was important to examine sleep in kids with mild to severe disease throughout childhood. We were also able to obtain data on the mothers of children with atopic dermatitis, and as the mother of two small children, I was particularly interested in the effects of chronic illness and sleep deprivation on families. 

Take me to the proudest moment of your career so far:
Many of our research questions have come from clinical practice, and I find it incredibly satisfying when I can give a patient better prognostic information or treatment recommendations based on research I’ve participated in. 

Disclosures:

Dr. Abuabara is on the academic steering committee for TARGET-DERM, a company developing an atopic dermatitis disease registry and she receives research funding through her institution from Pfizer.

References:

1. Ramirez FD, Chen S, Langan SM, et al. Assessment of Sleep Disturbances and Exhaustion in Mothers of Children with Atopic Dermatitis. JAMA Dermatol. 2019. doi: 0.1001/jamadermatol.2018.5641