Sleep quality in infants with atopic dermatitis: impact of lesion location and disease severity in a retrospective cross-sectional study

Abstract

Atopic dermatitis (AD) is a common inflammatory skin disorder in infants and is frequently associated with sleep disturbances. Although the relationship between disease severity and sleep quality is well established, the effect of lesion localization on sleep has not been thoroughly investigated. This retrospective cross-sectional study included 60 infants aged 6–36 months diagnosed with AD and 60 age-matched healthy controls. Sleep quality was assessed using the Children’s Sleep Habits Questionnaire (CSHQ), which, although originally developed for older children, has been used in younger populations in previous studies. Disease severity was evaluated using the Scoring Atopic Dermatitis (SCORAD) and Patient-Oriented Eczema Measure (POEM) indices. Lesion localization was determined through clinical examination and categorized as face/neck, trunk/extremities, or generalized (involvement of two or more regions). Parametric and nonparametric tests were used for intergroup comparisons. Relationships between variables were examined using Spearman’s correlation analysis, and multivariate regression analysis was employed to identify independent associations. The AD group exhibited significantly higher total CSHQ scores ( p < 0.001). Sleep onset latency, night awakenings, bedtime resistance, and sleep duration problems were more pronounced in infants with AD. Positive correlations were observed between SCORAD/POEM scores and CSHQ scores ( p < 0.001). Infants with facial and neck involvement had lower sleep quality compared to those with lesions confined to the trunk and extremities ( p < 0.01). The greatest degree of sleep disturbance was observed in infants with generalized involvement. In infants with AD, both disease severity and lesion localization are associated with poorer sleep quality. The finding that facial and neck involvement is linked to greater sleep disturbance highlights the importance of considering anatomical distribution during clinical assessment. Early interventions, including regular emollient use and proactive anti-inflammatory treatment, may help mitigate potential cognitive, emotional, and behavioral risks in this vulnerable age group.