Department of Dermatology and Immunodermatology, Medical University of Warsaw, Warsaw, Poland.
Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland.
Clin Exp Dermatol. 2019 Oct;44(7):759-765. doi: 10.1111/ced.13902. Epub 2019 Jan 16.
Bullous pemphigoid (BP) is a distressing autoimmune bullous disease strongly associated with severe pruritus; however, data concerning pruritus in BP are still scarce. No clinical research evaluating the effect of BP on sleep quality has been conducted.
To evaluate the intensity of pruritus measured by nocturnal wrist movements (NWMs) and the sleep quality in patients with BP using actigraphy in comparison with nonpruritic healthy controls (HCs) with subsequent correlations with an itch visual analogue scale (VAS) as a subjective measure, disease severity [Bullous Pemphigoid Disease Area Index (BPDAI), urticaria/erythema, erosions/blisters] and serum total IgE level.
In total, 31 patients with newly diagnosed BP (mean ± SD age 75.4 ± 12.3 years) and 40 nonpruritic HCs (age 73.5 ± 11.7 years) were recruited. All participants wore a sleep monitor (ActiSleep+) on the dominant wrist.
For patients with BP, median VAS score was 5.5 and median BPDAI was 43 (urticaria/erythema BPDAI was 16, erosions/blisters BPDAI was 29). Scratching, defined as bouts of NWMs, was significantly (P < 0.001) more intensive in patients with BP than in controls. Characteristic of BP was that scratching bouts corresponded with the slowest wrist movements. There were no correlations with VAS, BPDAI or total IgE level. Compared with HCs, patients with BP presented significant (P < 0.001) sleep disturbances, as determined by sleep efficiency, waking after sleep onset and average duration of awakening, and these were strongly correlated with urticaria/erythema BPDAI.
Nocturnal wrist movements measured by actigraphy are more intensive in patients with BP than in nonpruritic HCs, and characteristically slow movements. Actigraphy method showed very low sleep quality in patients with BP, thus severity of BP has a negative impact on sleep.
大疱性类天疱疮（BP）是一种令人痛苦的自身免疫性大疱性疾病，与严重瘙痒强烈相关；然而，关于 BP 瘙痒的数据仍然很少。没有临床研究评估 BP 对睡眠质量的影响。
使用活动记录仪评估夜间腕部运动（NWMs）测量的瘙痒强度和 BP 患者的睡眠质量，并与非瘙痒性健康对照（HCs）进行比较，随后与瘙痒视觉模拟量表（VAS）作为主观测量、疾病严重程度[大疱性类天疱疮疾病面积指数（BPDAI）、荨麻疹/红斑、糜烂/水疱]和血清总 IgE 水平进行相关性分析。
共招募了 31 名新诊断为 BP 的患者（平均年龄±标准差为 75.4±12.3 岁）和 40 名非瘙痒性 HCs（年龄 73.5±11.7 岁）。所有参与者均在优势手腕上佩戴睡眠监测器（ActiSleep+）。
对于 BP 患者，VAS 评分中位数为 5.5，BPDAI 中位数为 43（荨麻疹/红斑 BPDAI 为 16，糜烂/水疱 BPDAI 为 29）。与对照组相比，BP 患者的搔抓（定义为 NWMs 发作）明显更剧烈（P<0.001）。BP 的特征是搔抓发作与最慢的手腕运动相对应。与 VAS、BPDAI 或总 IgE 水平无相关性。与 HCs 相比，BP 患者的睡眠效率、入睡后觉醒和平均觉醒持续时间均出现显著（P<0.001）的睡眠障碍，这些与荨麻疹/红斑 BPDAI 强烈相关。
与非瘙痒性 HCs 相比，活动记录仪测量的夜间腕部运动在 BP 患者中更为剧烈，且运动特征缓慢。活动记录仪法显示 BP 患者的睡眠质量非常低，因此 BP 的严重程度对睡眠有负面影响。
