Sleep and Limb Movement Characteristics of Children With Atopic Dermatitis Coincidentally Undergoing Clinical Polysomnography

Abstract

Study objectives: Atopic dermatitis (AD) is a prevalent, chronic, itchy skin condition. Children undergoing polysomnography (PSG) may coincidentally have AD. Many children with AD have sleep disturbances. Our study aimed to characterize limb movements in children with AD and their effect on sleep.

Methods: A retrospective chart review was conducted for children who underwent comprehensive attended PSG and had AD. PSG sleep parameters were compared to published normative data. A subset of patients with markedly elevated total limb movements was further compared to a matched group of patients with a diagnosis of periodic limb movement disorder (PLMD) and no history of AD.

Results: There were 34 children with AD 6.36 ± 3.21 years (mean ± standard deviation), 50% female and with mild to moderate AD. There was increased wake after sleep onset (WASO = 46.0 ± 37.8 minutes), sleep onset latency (46.5 ± 53.0 minutes) and total limb movement index (13.9 ± 7.5 events/h) compared to normative values. Although our cohort was mostly mild AD, 7 of the 34 children with AD (20%) had a total limb movement index during sleep > 15 events/h. Increased total limb movements in PLMD versus patients with AD was most notable during stage N2 sleep (38 ± 17 versus 22 ± 7, P = .01, respectively).

Conclusions: We found altered PSG parameters in children with AD, suggesting that clinicians should consider the diagnosis when affected children undergo PSG. Although our AD cohort was mild, we still determined a need to consider AD when diagnosing PLMD given the presence of elevated total limb movements in children with AD.

Citation: Treister AD, Stefek H, Grimaldi D, Rupani N, Zee P, Yob J, Sheldon S, Fishbein AB. Sleep and limb movement characteristics of children with atopic dermatitis coincidentally undergoing clinical polysomnography. J Clin Sleep Med. 2019;15(8):1107-1113.

Keywords: atopic dermatitis; periodic limb movements of sleep; polysomnography; pruritus; sleep.

Figure 1. Flow chart and study design.

(A) Flow chart of patients included in the AD final analysis cohort with reasons for exclusion. (B) Overall study design. Step 1 compares PSG parameters in children with AD undergoing PSG versus the general population. Step 2 compares limb movement analyses and PSG in a subset of children with AD and elevated limb movements versus PLMD. AD = atopic dermatitis, AHI = apnea-hypopnea index, CPAP = continuous positive airway pressure, EMR = emergency medical record, PLM = periodic limb movement, PLMD = periodic limb movement disorder, PSG = polysomnography.

Figure 2. Box plots showing temporal distribution of total limb movements and arousals for children with PLMD (n = 7) and children with m-AD with elevated limb movements (n = 7).

(A) Box plots show a significantly decreased LMI in children with PLMD during wakefulness and a significantly increased LMI during stage N2 sleep as compared to children with m-AD. (B) Box plots show significantly increased total limb movements associated with arousal indexes in children with PLMD for stage N2 sleep and total sleep as compared to children with m-AD. AD = atopic dermatitis, LMI = total limb movement index, m-AD = mild-to-moderate atopic dermatitis, PLMD = periodic limb movement disorder, REM = rapid eye movement.