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.