P169 Children with active atopic dermatitis and sleep disturbance have a greater risk of mental health conditions: a retrospective matched cohort study in England

Abstract

Paediatric patients with atopic dermatitis (AD) often experience sleep disturbance, which can have profound day-to-day effects. However, there is little research on the associations between mental health and sleep disturbance in these patients. We aimed to quantify the burden of mental health conditions in paediatric patients with AD and sleep disturbance. We carried out a retrospective observational matched-control study including paediatric patients aged 2–17 years registered within the Clinical Practice Research Datalink (CPRD) Aurum database of primary care records (1 March 2003 to 1 March 2023). We included all paediatric patients with active AD, identified using a validated algorithm using AD-specific diagnostic codes and at least two prescribed AD treatments. Paediatric patients with active AD were divided into two groups based on the existence of a recorded sleep disturbance event after the onset of active AD. Those with active AD and sleep disturbance (cases) were matched up to 1 : 4 with those with active AD but without recorded sleep disturbance (matched controls). Associations with mental health conditions – including anxiety, attention deficit/hyperactivity disorder (ADHD), behavioural/conduct disorders and depression – were evaluated using Cox regression, with models adjusted for sociodemographic factors and baseline comorbidities. In total, 16 882 cases were matched to 66 862 controls, with 84% aged 2–11 years. The median follow-up was 1.3 years for cases (interquartile range 0.61–2.96) and 1.05 years for controls (interquartile range 0.48–2.13). Active AD with sleep disturbance was associated with an increased risk of anxiety [adjusted hazard ratio (aHR) 1.69, 95% confidence interval (CI) 1.42–2.00], ADHD (aHR 2.18, 95% CI 1.70–2.80), behavioural or conduct disorders (aHR 1.89, 95% CI 1.51–2.37) and depression (aHR 1.59, 95% CI 1.18–2.15). Paediatric patients with active AD who report sleep disturbance to primary care show a marked association with mental health conditions. The co-occurrence of these conditions suggests that greater support and targeted management of both AD and sleep disturbance during childhood may help reduce the burden of mental health conditions.