Prevalence of sleep disorders in patients with bullous pemphigoid

Alleviating sleep disturbances is a key therapeutic goal in pruritic dermatoses. However, sleep disturbance remains under-investigated in patients with bullous pemphigoid (BP), despite contributing to exhaustion in older adults and potentially increasing disease morbidity.

To estimate the prevalence and severity of insomnia in BP patients, and examine its correlation with disease activity, self-rated pruritus, and quality of life (QoL).

A national, multicenter, controlled study in 61 BP patients and 61 age- and sex-matched controls. Insomnia severity was assessed via the Insomnia Severity Index (ISI), BP activity via the Bullous Pemphigoid Disease Area Index (BPDAI), and QoL via the Autoimmune Bullous Disease Quality of Life (ABQOL) and ItchyQoL scores. Pruritus severity was rated using a numerical scale (NRS-pruritus). All assessments were repeated after one month of treatment.

Significant sleep disorders (ISI ≥ 15) were observed in 34.4 % of cases and 8.5 % of controls (RR: 4.04; 95 % CI: 1.64-10.06; p = 0.0025). Significant sleep disorder was associated with higher ItchyQoL, ABQOL, and NRS-pruritus scores. However, the ItchyQoL score was the only independent factor (OR = 1.13; 95 % CI: 1.02-1.25). After one month of treatment, significant insomnia decreased by 56.2 % compared to baseline (p < 0.001).

BP is associated with a four-fold risk of insomnia compared to age- and sex-matched controls. Screening for insomnia and promoting sleep quality should be part of BP treatment strategies.