Sleep Disturbance and Psychological Stress: Two Interconnected Conditions in Chronic Spontaneous Urticaria

Chronic spontaneous urticaria (CSU) is a common disease characterized by wheals and/or angioedema. Since it is a chronic, itch-related disease, it may substantially affect the psychological status and quality of sleep. In this study, it was aimed to evaluate the impact of CSU on depression, anxiety, stress, and quality of sleep, as well as their relation to disease-specific factors.

This prospective case-control study included 86 patients with CSU and 86 controls. The sociodemographic and clinical characteristics of the patients, such as scores of urticaria activity score (UAS7) and chronic urticaria quality of life questionnaire (CU-Q2oL), were recorded. Depression, Anxiety, and Stress Scales-21 (DASS-21), Pittsburgh Sleep Quality Index (PSQI), and Dermatology Life Quality Index (DLQI) were used to evaluate their psychological status, quality of sleep, and life.

Of 172 participants, the patient group comprised 86 patients with CSU, and the control group comprised 86 age and sex-matched volunteers. Of 86 patients with CSU, 60 (69.8%) were females and 26 (30.2%) males with a median age of 34.5 years. In the patients with CSU, the median scores (interquartile range) for depression, anxiety, and stress, according to DASS-21, were 6 (8), 5 (6.25) and 6 (7), respectively. Additionally, the median scores of PSQI and DLQI were 7 (5) and 5.5 (11), respectively. The median scores for depression, anxiety, and stress according to DASS-21, the median scores of PSQI and DLQI were statistically significantly higher in the patient group than in the control group. According to the PSQI classification, 68 (79.1%) patients had poor sleep quality, while 18 (20.9%) patients had good sleep quality. When the patient group was examined in two groups, those with good and poor sleep quality, UAS7, depression, anxiety, stress, and DLQI/CU-Q2oL scores were statistically significantly higher in the patients with poor sleep quality than in the patients with good sleep quality.

Treatment of urticaria is typically symptomatic and aims to reduce the symptoms of itching and wheals. However, clinicians can contribute to the well-being of patients if they are aware of psychological comorbidities and sleep disturbances.