Participants and procedures
We conducted a descriptive, cross-sectional, case-control, observational study. AD patients were recruited from the AD outpatient clinics at the Dermatology Departments of San Salvatore Hospital (University of L’Aquila, Italy) from July 2020 to December 2021. Inclusion criteria for AD patients were as follows: (i) Adult patients affected by AD according to Hanifin’s and Rajka’s diagnostic criteria; (ii) Patients who voluntarily signed informed consent on the study objectives; (iii) Patients able to complete the questionnaires through a digital medium. Exclusion criteria consisted of (i) patients affected by other cutaneous and systemic disorders, (ii) patients with a previous diagnosis of a psychiatric disorder or psychological symptoms, and (iii) patients being treated with systemic drugs that interfere with sleep, excluding agents for the treatment of AD. The control group comprised healthy individuals without skin diseases and a prior diagnosis of psychiatric and psychological conditions, recruited both in outpatient Dermatology Departments and among family members of AD patients. Control participants were matched to each AD patient for age (± 1 year) and sex, as these two demographic factors are associated with different sleep and psychological characteristics27–30.
The AD group underwent a clinical evaluation in which AD characteristics were collected by experienced dermatologists using the Eczema Area and Severity Index31 (EASI), a reliable and sensitive tool for assessing the physical signs of AD/eczema. The total EASI score ranges from 0 to 72, with the highest score indicating more severe atopic dermatitis symptoms.
Subsequently, AD participants were invited to complete an online survey via Google Forms collecting information on age, sex, self-perceived atopic eczema severity, sleep quality and insomnia severity symptoms using the Patient-Oriented Eczema Measure32 (POEM), the Pittsburgh Sleep Quality Index33 (PSQI) and the Insomnia Severity Index34 (ISI), respectively.
The (POEM) is a validated, patient-oriented assessment measure for monitoring the severity of atopic eczema. A higher score suggests more severe AD symptoms (range 0–28). The PSQI is a 19-item questionnaire widely used to evaluate sleep quality. A higher total score (range 0–21) indicates more severe sleep problems. The ISI is a 7-item clinical tool to assess insomnia severity (range 0–28). A higher score indicates more severe insomnia symptoms. We also assessed depressive symptoms, anxiety, and perceived stress through a set of validated questionnaires: the Beck Depression Inventory-second edition35 (BDI-II), the Generalized Anxiety Disorder-736 (GAD-7), and the 10-item Perceived Stress Scale37 (PSS-10), respectively. The BDI-II is a 21-item questionnaire used in clinical practice to evaluate depressive symptoms (range, 0–63). A higher score denotes greater severity of depressive symptoms. The GAD-7 is a validated 7-item questionnaire for screening symptoms of generalized anxiety and assessing its severity in clinical practice and research. A higher total score (range 0–21) reflects more severe anxiety. The PSS-10 is a 10-item questionnaire evaluating thoughts and feelings related to stressful events. A higher total score (range 0–40) indicates more significant perceived stress.
Likewise, the control group completed an online survey in which sleep quality, insomnia, depression, anxiety, and perceived stress were examined using the same validated questionnaires.
The study was approved by the Institutional Review Board of the University of L’Aquila (protocol number 35/2020). Online informed consent was obtained from all participants, who consented to the publication of the questionnaire results for scientific purposes.