Parents Lose Sleep to Kids’ Eczema

Parents of children with eczema are more likely to be short on sleep and to use medication to try to get more of it, a retrospective National Health Interview Survey (NHIS) analysis showed.

In a sample weighted to be nationally representative, 45.2% of those who reported having a child with atopic dermatitis (AD) did not get the minimum recommended 7 hours of sleep per night, and 13.3% took medications to aid sleep, compared with 37.1% and 9.9%, respectively, of parents whose children did not have AD, reported Dawn Siegel, MD, of Stanford University School of Medicine in California, and colleagues.

After adjusting for sociodemographic characteristics, pediatric atopic conditions, pediatric and parental health status, citizenship status, and parental age and sex, the odds ratios were 0.78 (95% CI 0.72-0.85) for not meeting American Academy of Sleep Medicine recommendations and 1.26 (95% CI 1.12-1.43) for taking any sleep aids in the prior week, the group detailed in Pediatric Dermatology.

“When a child has atopic dermatitis, his or her parents effectively have it as well,” commented Brittany Craiglow, MD, of Yale University in New Haven, Connecticut.

“Whether it is spending time applying topicals or waking up in the night with their itchy child, the impact on parents cannot be understated. This information underscores the importance of taking a thorough history when evaluating a pediatric patient with AD [atopic dermatitis], inquiring not only about the impacts on the child but also the rest of the family,” said Craiglow, who was not involved in the research.

Decreased sleep is linked to health issues including hypertension, diabetes, and stroke, Siegel’s group noted. They cited an American Time Use Survey analysis that linked even 19 minutes of lost sleep to obesity and cardiovascular disease, “indicating that even small amounts of consistent sleep loss and the resulting circadian rhythm disruptions can be associated with negative health consequences.”

While sleep disruption may be a well-recognized phenomenon among parents of children with atopic dermatitis, there are things that can be done to help, said Shoshana Marmon, MD, PhD, of New York Medical College in Valhalla, New York.

“Aggressively managing the child’s AD, specifically nighttime pruritus, to reduce disruptions would inevitably help to minimize sleep medication use among parents,” she told MedPage Today.

“Physicians should educate parents on the link between AD and sleep disturbances and optimize management of AD-related symptoms through effective medical treatments,” added Marmon, who also was not involved in the study. “Physicians could also encourage non-pharmacologic approaches, such as improved sleep hygiene and behavioral therapy, to decrease medication reliance. And referrals to sleep specialists for severe cases may also be beneficial.”

For the study, Siegel and co-authors analysed data from the 2013 to 2018 NHIS, which covers some 35,000 civilian households annually. The study included 5,583 parents in households reporting having a child with atopic dermatitis and 37,420 in households without parent-reported atopic dermatitis. With weighting, this represented 6.1 million U.S. parents (≥60% female) who reported having a child with atopic dermatitis (mean age 7.9 years) and 41.3 million whose children did not have atopic dermatitis (mean age 8.4 years).

Authors noted that while response rates declined over the survey period, the NHIS design adjusts for participant nonresponse and bias due to under-coverage and ensures that the survey remains nationally representative.

Craiglow noted that the study period (2013 to 2018) “was prior to the approval of multiple advanced therapies for atopic dermatitis in children and adolescents. Given that we now have more effective treatment options, I am hopeful that the numbers of parents who are so dramatically affected is different today.”

Siegel and co-authors acknowledged study limitations, including that the cross-sectional nature of the study prevents causal conclusions and that the interpretation of the findings is limited by the absence of information regarding severity of the child’s atopic dermatitis, the exact amount of parental sleep loss, or the specific sleep medications used.

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