OBJECTIVES : Atopic dermatitis (AD) is a common allergic disease affecting 2.1% to 4.9% adults worldwide. Itch is an integral part of AD and is known to negatively influence the different aspects of well-being including sleep disturbance, which can further be associated with poor health outcomes in adults. The current research is designed to identify and summarise the studies reporting the impact of itch on sleep among adult AD patients.

METHODS : A targeted search of published literature was performed using Embase^® and MEDLINE^® from database inception to December 2019. A bibliographic search of relevant reviews was also performed. Studies providing the itch related sleep disturbance data in adult AD patients were included in the review.

RESULTS : Of the 518 screened citations, 17 studies met the inclusion criteria. Eight studies were conducted in the USA, three in Japan, two in Poland, and one each in Korea, France, Denmark, and Global. The majority of studies assessed the impact of itch on sleep parameters using self-report questionnaires (n=08), and PSQI (n=06), followed by the actigraphy (n=03), VAS, POEM-sleep, SCORAD-sleep, 5D-sleep (two studies each) and polysomnography, PROMIS, AIS, and ItchyQOL-sleep (one study each). The proportion of patients reporting difficulty falling asleep ranged from 54% to 85% among the studies reporting the impact of itch on sleep. Four studies comparing AD and control subjects reported significantly higher sleep disturbance, poor sleep quality, and daytime sleepiness in AD. Most studies indicated a positive association between itch and sleep disturbance and an inverse correlation between QOL and severity of itch and sleep disturbance i.e. ↑AD severity→↑Itch→↑Sleep disturbance→↓QoL.

CONCLUSIONS : Sleep disturbance and quality has a substantial association with itch and could be an important mediator of the inverse association between itch and QoL. Instruments assessing sleep should be incorporated into routine practice for sleep disturbance diagnosis and management in AD patients.