The association between pruritic dermatoses and inflammatory factors on sleep disorders: a cross-sectional study of the National Health and Nutrition Examination Survey (NHANES)

Pruritic dermatoses and sleep disorders have significant impacts on the health and quality of life of patients. Inflammatory conditions may lead to the sensation of itching. This study was to evaluate the association between pruritic dermatoses and inflammatory factors on sleep disorders. Data in the cross-sectional study were extracted from the National Health and Nutrition Examination Survey. The study population was divided into participants with and without sleep disorders. Pruritic dermatoses were assessed by the participant’s self-report. Inflammatory factors included white blood cell count (WBC), lymphocyte count (LYM) and prognostic nutritional index (PNI). Logistic regression models were used with odds ratios and confidence intervals. The attributable proportion of interaction (AP) was utilized to assess the interaction between pruritic dermatoses and inflammatory factors on sleep disorders. Totally, 3,520 participants were included and 214 (6.08%) had sleep disorders. Pruritic dermatoses were associated with sleep disorders after adjusting for gender, age, race, marital status, body mass index, drinking, smoking, asthma, hay fever, allergy, depression and caffeine. LYM was associated with sleep disorders when inflammatory factors were divided by median. The interaction between participants without pruritic dermatoses and PNI < median on sleep disorders was observed compared to participants without pruritic dermatoses and PNI > median. Pruritic dermatoses were significantly associated with sleep disorders. We also found that a high level of PNI had an enhanced effect on the relationship between pruritic dermatoses and sleep disorders. Clinicians should focus on the potential sleep-related risks and changes in inflammatory factors in patients with pruritic dermatoses and intervene in time.

瘙痒性皮肤病（pruritic dermatoses）与睡眠障碍（sleep disorders）对患者的健康及生活质量具有显著负面影响。炎症状态可引发瘙痒感。本研究旨在探讨瘙痒性皮肤病与炎症因子对睡眠障碍的关联。本横断面研究的数据提取自美国国家健康与营养检查调查（National Health and Nutrition Examination Survey）。研究对象被划分为睡眠障碍组与非睡眠障碍组。瘙痒性皮肤病通过受试者自我报告进行评估。炎症因子涵盖白细胞计数（WBC）、淋巴细胞计数（LYM）及预后营养指数（PNI）。本研究采用logistic回归模型进行分析，报告比值比与置信区间，并使用交互归因比例（AP）评估瘙痒性皮肤病与炎症因子对睡眠障碍的交互作用。本研究共纳入3520名受试者，其中214名（6.08%）存在睡眠障碍。在校正性别、年龄、种族、婚姻状况、体质量指数（body mass index, BMI）、饮酒、吸烟、哮喘、花粉症、过敏、抑郁及咖啡因摄入等混杂因素后，瘙痒性皮肤病与睡眠障碍存在显著关联。当按中位数划分炎症因子水平时，淋巴细胞计数与睡眠障碍存在关联。与无瘙痒性皮肤病且预后营养指数≥中位数的受试者相比，无瘙痒性皮肤病且预后营养指数＜中位数的受试者与睡眠障碍间的交互作用显著。本研究证实，瘙痒性皮肤病与睡眠障碍显著相关；同时发现，较高的预后营养指数可增强瘙痒性皮肤病与睡眠障碍之间的关联。临床医师应关注瘙痒性皮肤病患者潜在的睡眠相关风险及炎症因子变化，并及时开展临床干预。