Measuring Sleep Disturbance in Atopic Dermatitis: Patient-Reported Versus Objective Outcomes

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To the Editor:
We thank Professor Kawada for his commentary1 on our study of the burden of sleep and fatigue in US adults with atopic dermatitis (AD).2 In our study, we sought to determine the impact of sleep disturbance and fatigue on instrumental activities of daily living (IADLs) and health-related quality of life (HRQOL) in adults with AD. The study used a survey-based approach, that is, patient-reported outcomes (PROs), to capture the impact of sleep disturbance and fatigue on IADLs and HRQOL.
Kawada suggested that objective monitoring of physiological sleep parameters should also be considered to confirm the association between AD and sleep. We agree with this suggestion. There are many ways of assessing sleep disturbance. Objective tests, such as polysomnography and actigraphy, describe important characteristics of sleep, including delayed onset, number and duration of awakening, and overall sleep efficiency. In fact, these approaches have been implemented to study sleep disturbances in AD before,3,4 and more studies using objective sleep assessments are warranted in AD. However, sleep disturbances can differentially impact patients' HRQOL depending on the nature, severity, and chronicity of the sleep disturbance, as well as the patients' baseline age, level of activity, and vitality. Thus, objectively measured sleep characteristics do not always correlate perfectly with HRQOL disturbances. In our study, we a priori sought to understand the impact of sleep disturbance and fatigue on IADLs and HRQOL. Thus, using PRO was deemed the best approach.
Kawada also suggested that prospective studies would better establish causation. We definitely agree because this is true for any research question. Indeed, prospective studies are underway by our group and others using both objective assessments and PRO to better understand the relationship between AD and sleep.

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