722 CLINICAL REPORT
ActaDV ActaDV Advances in dermatology and venereology Acta Dermato-Venereologica
Usability of Validated Sleep-assessment Questionnaires in Patients with Chronic Pruritus : An Interview-based Study
Theresa SUILMANN , Claudia ZEIDLER , Nani OSADA , Claudia RIEPE and Sonja STÄNDER Center for Chronic Pruritus , Department of Dermatology , University Hospital Münster , Münster , Germany
Impaired sleep due to nocturnal pruritus is a common symptom in patients with chronic pruritus . How ever , there is no standardized , simplified instrument for assessing sleep-related problems in patients with chronic pruritus . After a literature search , we conducted 50 interviews with patients with chronic pruritus and tested 12 items most frequently used in routine sleep questionnaires . Afterwards , 2 sleep assessment questionnaires ( Pittsburgh Sleep Quality Index ; Regensburg Insomnia Scale ) were selected for use in 88 patients with chronic pruritus with sleep impairment due to pruritus . They were completed twice ; once before optimizing their individual pruritus therapy and once again after 4 weeks . During the latter survey , 21 patients reported that pruritus no longer negatively affected their sleep . These patients also achieved a significant improvement in their sleeping behaviour in the Regensburg Insomnia Scale . Therefore , the Regensburg Insomnia Scale appears to be well-suited to assessing sleep impairment in patients with chronic pruritus .
Key words : itch ; nocturnal pruritus ; sleep assessment ; prurigo ; clinical trial .
Accepted Apr 24 , 2018 ; Epub ahead of print Apr 24 , 2018 Acta Derm Venereol 2018 ; 98 : 722 – 727 .
Corr : Sonja Ständer , Department of Dermatology and Center for Chronic Pruritus , University Hospital Münster , Von-Esmarch-Str . 58 , DE-48149 Münster , Germany . E-mail : sonja . staender @ uni-muenster . de
Chronic pruritus ( CP ), defined as pruritus persisting for more than 6 weeks ( 1 ), is a frequent subjective symptom in the general population , with an estimated lifetime prevalence between 22 % and 25.5 % ( 2 , 3 ). Efforts are currently underway to standardize and validate instruments used to measure CP , especially due to its subjective nature ( 4 ). The documentation of the intensity of the pruritus and its influence on numerous aspects of quality of life ( QoL ) serve as the basis for an assessment of the efficacy of a treatment . One important aspect is the determination of sleep patterns , since CP often results in sleep disturbances . Up to 90 % of patients with CP report impaired sleep due to nocturnal pruritus ( 5 ). Because sleep disturbances are only marginally addressed in current , standardized instruments for the QoL , assessments of sleep quality in patients with CP have thus far remained insufficient ( 6 ). A more detailed description of specific sleep-related problems could be useful for optimizing and adapting a therapy . The International Forum for the Study of Itch ( IFSI ) provides a general recommendation regarding which specific sleep instruments
SIGNIFICANCE
Chronic pruritus ( CP ) is a common symptom in the general population . In some patients the itching occurs predominantly at night . Accordingly , sleep patterns can be partly negatively affected . In this study , pruritus-related sleep impairments ( especially waking up in the middle of the night or too early in the morning because of pruritus ) were identified . In addition , we found that one already existing , validated sleep assessment questionnaire , the Regensburg Insomnia Scale , captures the specific sleep restrictions of patients with CP and detect any positive therapy effects on patients ’ sleep .
might be suitable ( 4 ). Several validated sleep assessment questionnaires described in the literature assess sleep impairment in a detailed manner ; however , none of these instruments has been validated for use in patients with CP .
The aims of this study are to determine whether validated sleep questionnaires are able to detect specific sleep restrictions in patients with CP , and to attempt to define which questionnaire is most suitable to fulfil this task .
MATERIALS AND METHODS
This study was conducted at the Center for Chronic Pruritus in the Department of Dermatology at the University Hospital Münster from November 2014 to December 2016 .
Literary research
To obtain an overview of current validated sleep questionnaires , literary research ( step 1 ) was performed using databases such as PubMed ( US National Institute of Health ’ s National Library of Medicine ) on 19 December 2014 .
Interviews and testing the items most frequently asked in routine sleep questionnaires
For the next step , the informed consent of 50 patients ( age ≥18 years ) was obtained prior to conducting interviews regarding their sleep behaviour ( step 2 ) and testing of 12 items most commonly used in routine sleep questionnaires ( step 3 ). In this collective , all patients with CP were admitted , regardless of the existence of impaired sleep due to nocturnal pruritus , with the aim of gaining an overview of the prevalence of sleep impairment in patients with CP and to obtain a first impression of which sleep areas might be affected the most in this collective . Firstly , patients were prompted to describe , in their own words , their sleep patterns in the last 4 weeks , including any sleep problems . Post-interview , each patient was asked to complete an additional questionnaire comprised of the 12 items most frequently asked in examined sleep questionnaires , in order to increase the comparability of patients ’ statements . doi : 10.2340 / 00015555-2947 Acta Derm Venereol 2018 ; 98 : 722 – 727
This is an open access article under the CC BY-NC license . www . medicaljournals . se / acta Journal Compilation © 2018 Acta Dermato-Venereologica .