Weekend Catch-Up Sleep Prevents Suicidal Ideation in Adolescent Patients With AD, Study Says

Prolonged weekend catch-up sleep (WCUS) could be considered a protective factor against suicidal ideation in adolescent patients with atopic dermatitis (AD), according to a study published in the Journal of Clinical Medicine.

The researchers explained that AD impairs patients’ quality of life in many ways, including their sleep quality. They noted that prior research found that itching and pain from AD can impair patients' sleep, resulting in trouble falling asleep, excessive daytime sleepiness, and frequent nighttime awakenings. Consequently, 47% to 80% of children with AD, and 33% to 87.1% of adults with AD, reported sleep disturbance.

Sleep disturbance may lead to depression and suicidal ideation, and the researchers noted that it is often considered a measure of AD disease severity. Previous studies reported that patients with AD are 44% more likely to have suicidal ideation and 36% more likely to attempt suicide than those without AD.

Due to sleep disturbance, some patients use WCUS to compensate for insufficient weekday sleep. Although WCUS has been associated with positive health effects, like lowered risk of hypertension, it also has been connected to some negative effects, like increased risk of suicide attempts and self-injury in children and adolescents. Despite the history of sleep disturbance and suicidal ideation in adolescents with AD, the researchers noted that there have been no studies on whether or not WCUS influences suicidal ideation in adolescents with AD.

“Because current suicidal ideation is the most important predictor of future suicide attempts, and adolescents with AD have a higher prevalence of suicidal behaviors, identifying sleep factors associated with suicidal ideation in adolescents with AD may assist with the effort to reduce suicide in this group,” the authors wrote.

Sleeping adolescent patient | Image Credit: Rawpixel.com - stock.adobe.com

To conduct the study, the researchers performed a comparative analysis examining differences in clinical characteristics, sleep patterns, and mental health status to identify sleep factors associated with suicidal ideation in adolescents with AD. Their study population consisted of respondents from the third through eleventh Korean Youth Behavior Web-Based Surveys (KYRBSs) conducted from 2013 to 2017. KYRBS is an anonymous, self-administered online survey that encompasses a nationally representative sample of Korean adolescents aged 12 to 18 years.

Of the 352,652 targeted adolescents, 340,342 completed the survey, resulting in a total response rate of 96.5% (range, 95.8%-97.2%). The researchers excluded 47,851 of these participants for either not providing logically consistent sleep records or submitting data considered as missing values. Consequently, the study population consisted of 71,434 adolescents with AD and 221,057 without AD. The mean (SD) age of the participants was 15.01 (1.75) years, and AD was prevalent in 24.4% of participants.

The researchers found sleep satisfaction to be significantly poorer among the AD group as 45.4% of those with AD noted that they do not get enough sleep compared with 40.9% of those without AD. Also, based on the mean (SD) hours of sleep reported, adolescents with AD slept less than those without AD, recording 6.69 (1.47) and 7.63 (1.50) hours of sleep, respectively. Similarly, 8.1% of participants with AD got less than 5 hours of sleep compared with 7.2% of participants without AD.

Additionally, they found adolescents with AD to report a greater mean number of WCUS hours at 2.33 (1.79) hours, compared with adolescents without AD at 1.95 (1.03) hours. Consequently, 44.3% of adolescents with AD and 36.9% of adolescents without AD experienced long WCUS. From this, the researchers discovered that long WCUS—defined as 2 hours or more of sleep on average during the weekends—was significantly associated with decreased suicidal ideation among adolescents with AD (OR, 0.87; 95% CI, 0.81-0.92). Because of this, the researchers suggested that adolescents with AD obtain a sufficient amount of sleep to reduce suicidal ideation.

The researchers acknowledged their study’s limitations, one being that almost all participants were Korean. Although this allows for the results to be generalized to all Korean patients, the same could not be done for those of other ethnicities. Also, the data utilized in this study was self-reported, meaning that the responses regarding exact sleep time are not as credible, and using a more objective sleep assessment is required to resolve this. Despite these limitations, the researchers made future suggestions based on their findings.

“Health care professionals, including pediatricians and dermatologists, need to be more aware of the risk of mental health problems and suicidality in adolescents with AD, particularly amongst those with sleep problems,” the authors concluded. “When treating adolescents with AD, screening procedures for associated sleep factors related to suicidality, including short sleep duration and sleep dissatisfaction, should be emphasized.”

Reference

Kang DW, Kim SH, Kyung Y, Lee HJ. Association of sleep duration and weekend catch-up sleep with suicidal ideation among adolescents with atopic dermatitis. Journal of Clinical Medicine. 2023; 12(24):7716. doi:10.3390/jcm12247716