Atopic Dermatitis and Excessive Daytime Sleepiness: Analysis of Data from 8362 Adult Subjects in a Sub-Saharan Africa Country

Abstract

Sleep disorders in patients with atopic dermatitis (AD) are common and can have a negative impact on the quality of life of the affected subjects. Very little data are available on the association between AD and excessive daytime sleepiness (EDS) in adults. The objective of this study was to compare the prevalence of EDS in subjects with AD and those without AD, and to investigate the determinants of EDS in adults with AD. In this cross-sectional population-based study conducted from 2015 to 2018 in Cameroon, adult subjects aged at least 19 years were included by multi-level stratified random sampling. AD was defined as the presence of a chronic itchy dermatitis evolving intermittently over a period of at least 6 months and electively affecting certain areas (fronts of the elbows, back of the knees, front of the ankles, under the buttocks, around the neck, around the eyes or ears) during the last 12 months preceding the survey. EDS was defined by an Epworth score≥10. Logistic regression was used to investigate the independent association between EDS and AD. A difference was considered significant if p<0.05. A total of 8362 subjects (55.2% women) with median age (25th-75th percentiles) of 39 (27-54) years were included. There were 217 subjects (2.6%) with AD and 1022 subjects (12.2%) with EDS. The prevalence of EDS was higher in subjects with AD than in those without AD (22.1% vs. 12%, p<0.001). In multivariate analysis integrating potential confounders (area of recruitment, age, education level, body mass index, association with other allergic diseases), AD remained independently associated with EDS with an adjusted odds ratio (95% CI) of 2.18 (1.54-3.08). No independent associated factors to EDS were found in subjects with AD. There is an independent association between EDS and AD, and nearly one quarter of patients with AD has EDS in this setting. It is necessary to consider the systematic evaluation of EDS in subjects with AD to optimize their management.