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. 2020 Dec;10(6):1359-1369.
doi: 10.1007/s13555-020-00451-2. Epub 2020 Sep 25.

Cyclosporine Improves Sleep Quality in Patients with Atopic Dermatitis

Ken-Ichi Yasuda  1 , Yozo Ishiuji  1 , Takuro Endo  2 , Katsumi Tanito  3 , Ryoichi Kamide  4 , Yoshimasa Nobeyama  5 , Akihiko Asahina  1
Affiliations

Cyclosporine Improves Sleep Quality in Patients with Atopic Dermatitis

Ken-Ichi Yasuda et al. Dermatol Ther (Heidelb). 2020 Dec.

Abstract

Introduction: Atopic dermatitis (AD) is a chronic, relapsing, inflammatory skin disease characterized by eczema and pruritus, and frequently impairs sleep quality. Although cyclosporine improves symptoms of AD, objective evaluation of sleep in patients with AD treated with cyclosporine has not been reported. This study was conducted to elucidate the effects of cyclosporine on sleep quality for patients with AD.

Methods: Twelve patients with moderate-to-severe AD were recruited. Nocturnal sleep quality was evaluated for 7 days using a sleep analyzer, which patients wore at the waist before and after cyclosporine was administered at 2.0-4.0 mg/kg per day. Seven parameters of sleep quality were measured before and after cyclosporine administration for a period of 7 days for each patient.

Results: The administration of cyclosporine significantly improved total sleep time in four cases, sleep latency in two cases, wake after sleep onset in six cases, number of awakenings in two cases, sleep efficiency in seven cases, number of awakenings for more than 8 min in three cases, and number of position changes recorded every 2 min in three cases. The mean values of sleep latency significantly decreased after cyclosporine administration (P = 0.023). The mean value of sleep efficiency significantly increased after the administration (P = 0.002).

Conclusion: Cyclosporine improves sleep quality in patients with moderate-to-severe AD.

Keywords: Atopic dermatitis; Cyclosporine; Pruritus; Quality of life; Sleep.

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Figures

Fig. 1
Fig. 1
Changes in sleep parameters from before to after cyclosporine. a Changes in each sleep parameter of individual patients. “Before” and “After” indicate time points before and after cyclosporine administration, respectively. b Changes in mean values of each sleep parameter. Asterisks indicate significant difference. Error bars represent standard deviation. TST total sleep time (minutes), SL sleep latency (minutes), WASO wake after sleep onset (minutes), NA number of awakenings (times), SE sleep efficiency (%), NA8 number of awakenings for more than 8 min (times), NPC number of position changes recorded every 2 min (times)
Fig. 2
Fig. 2
Statistical evaluations for sleep parameter changes in individual patients. Tile plot indicates statistical outcomes of changes in sleep parameters before and after cyclosporine administration of individual patients with AD. White, dark gray, and light gray squares indicate significant improvement, significant exacerbation, and no significant change, respectively. Diagonal marks in white squares indicate lack of data. Upper bar graph indicates number of patients showing significant improvements in each sleep parameter. Tile plot and bar graph share an x-axis, indicating each sleep parameter. TST total sleep time (minutes), SL sleep latency (minutes), WASO wake after sleep onset (minutes), NA number of awakenings (times), SE sleep efficiency (%), NA8 number of awakenings for more than 8 min (times), NPC number of position changes recorded every 2 min (times)
Fig. 3
Fig. 3
Hypothetical points where cyclosporine acts on sleep disturbance-related cytokines in atopic dermatitis. Hypothetical signaling pathway in sleep disturbance due to atopic eczema, and points where cyclosporine acts on the pathway are shown. CsA cyclosporine, TNFα tumor necrosis factor-α
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