Impact of sleep disturbance on mental health in schoolchildren with atopic dermatitis

Objective: This Taiwanese population-based cross-sectional (CARE) study examined associations between sleep disturbances and mental health symptoms in adolescents with atopic dermatitis (AD). Method: A cross-sectional analysis was conducted among 14,675 adolescents (median age: 12.6 years; 49.7% male) using validated self-report questionnaires to assess anxiety (Screen for Child Anxiety Related Emotional Disorders) and depression (Patient Health Questionnaire-9). AD was identified via physician diagnosis and self-reported symptoms. Sleep quality, frequency of disturbances, and daytime sleepiness were evaluated using self-report. Logistic regression models adjusted for sex and psychosocial factors were used to assess associations with mental health outcomes. Results: Adolescents with AD (n = 3470) had higher anxiety (18.7% vs 16.0%) and depression (4.2% vs 2.4%) prevalence than health controls (n = 7865) (P < 0.001). Among adolescents with AD, weekly sleep disturbances, poor sleep quality, and daytime sleepiness were independently associated with 2.1, 1.8, and 1.6-fold higher risks of anxiety and 4.4, 2.7, and 2.1-fold higher risks of depression, after adjustment for sex and psychosocial factors. A dose-response relationship was observed between the sleep disturbance frequency and symptom severity. Conclusion: Sleep disturbances are strongly associated with increased anxiety and depression symptoms in adolescents with AD. Interventions focusing on sleep and psychosocial stress may improve mental health outcomes in this vulnerable population.