AD Severity Linked With Sleep, Attention Issues in Young Children

Children with moderate to severe atopic dermatitis were found to be more likely to report suboptimal sleep and attention regulation outcomes.

Moderate to severe atopic dermatitis (AD) may increase the risk of sleep health and attention regulation issues in children, according to study findings published in Pediatric Dermatology.

Sleep disturbance and nigttime awakenings are common in children with AD, and their effects have been associated with daytime distraction and impaired attention. Moreover, AD has been noted to be a potential exacerbating risk factor of attentive issues in older children and adults, with prior studies indicating that poor sleepers with the condition were more likely to have these problems, including attention-deficit/hyperactivity disorder (ADHD), vs those without.

“To our knowledge, no studies exist on attention regulation and AD in children younger than 5 years old, beyond a single question about a diagnosis of attention-deficit/hyperactivity disorder (ADHD),” noted researchers. “This is likely due to the challenges of developmentally sensitive measurements of these domains during this period of rapid change and high rates of normative ability.”

Noting the recent development of sensitive tools to characterize attention, itch, and sleep, they conducted a cross-sectional study of children aged 1 to 4 years to examine the association between sleep and attentive issues in this patient population. Researchers also explored the association of AD severity with sleep health and attention regulation, and whether any targetable features could be derived from these associations to recommend treatment.

In the study, participants were stratifed by age, race/ethnicity, and disease severity, which was measured by the Patient-Oriented Eczema Measure. Attention dysregulation was measured by the Multidimensional Assessment Profile of Attention Regulation (MAPS-AR) tool, the impact of itch on quality of life was examined by the 6-item PROMIS Itch Questionnaire-Child (PIQ-C) scale, and sleep was characterized using an adapted Pediatric Sleep Practices Questionnaire (PSPQ) for 1- to 5-year-olds.

“The PROMIS EC Sleep Health Measure includes sleep disturbance and sleep-related impairment items, and a T-score was computed based on a custom set of questions,” they added.

Researchers collected 60 parent responses of US children with AD with a mean (SD) age of 2.78 (0.98) years who presented with severe (n = 25), moderate (n = 25), or mild (n = 10) disease.

A majority of children with moderate to severe AD (n = 43; 86%) were found to be significantly associated with reduced sleep health (T-score ≥ 60), in which 50% had 5 or more nights of disturbed sleep per week. A suboptimal sleep environment was also identified in 32% of children with moderate to severe AD, stemming from too much light, noise, or electronic device usage.

“Poor sleep resulted in significant mood impairment in children with moderate-to-severe AD compared with children with mild AD, with 36% having trouble getting along with other children and 68% crying easily because of poor sleep,” noted the study authors.

Regarding attention regulation in children with severe AD, 80% reported issues in sitting still and 72% cited trouble in paying attention no matter their surroundings. A reduced 40% of children with moderate AD and 20% of children with mild AD noted trouble in paying attention no matter their surroundings (P = .01).

After adjusting for potential covariates, AD severity was shown to be a significant predictor of poor sleep health (B = 0.79; 95% CI, 0.31-1.28; P < .01) and attention dysregulation (B = 1.22; 95% CI, 0.51-1.93; P < .01).

“In addition to aggressive treatment of AD, clinicians should advise on modifiable sleep hygiene practices and consider screening for attention dysregulation in young children,” concluded researchers.


Zhou NY, Nili A, Blackwell CK, et al. Parent report of sleep health and attention regulation in a cross-sectional study of infants and preschool-aged children with atopic dermatitis. Pediatr Dermatol. 2022;39(1):61-68. doi:10.1111/pde.14889

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