Original Article

Sleep Disturbance in Patients with Lichen Simplex Chronicus and Its Relationship to Nocturnal Scratching: A Case Control Study

Authors: Rafet Koca, MD, Remzi Altin, MD, Numan Konuk, MD, H Cevdet Altinyazar, MD, Levent Kart, MD

Abstract

Background: Lichen simplex chronicus (LSC) is a common pruritic disorder resulting from repeated rubbing and scratching. Nighttime pruritus is a common feature in LSC and may disrupt the sleep pattern. The aim of this study is to determine whether there are sleep abnormalities in patients with LSC.


Patients and Methods: Fifteen patients with LSC and 15 age-, sex- and body mass index-matched control subjects were enrolled in the study. No participant had any other medical or psychiatric illness. All subjects were evaluated by overnight polysomnography, scratch electrodes, Epworth sleepiness scale and a general questionnaire for demographic data and sleep problems.


Results: There were no significant differences in the groups for total sleep time, sleep efficiency, sleep latency, rapid eye movement (REM) latency, percentage of stage 1 non-REM sleep and REM sleep. The percentage of stage 2 non-REM sleep was higher (P < 0.05) and the percentage of slow wave sleep (stages 3 and 4) was lower in the study group (P < 0.05) than in the controls. The patient group had a mean of 15.9 ± 7.5 arousal index and 22.8 ± 14.1 awakenings compared with 9.5 ± 3.1 and 10.4 ± 3.9, respectively, in the controls (P < 0.05, P < 0.01, respectively). Arousals of patients were mainly observed in non-REM sleep. The number of scratching bouts ranged from 6 to 20 per night. Scratching episodes were observed frequently during stage 2 non-REM sleep.


Conclusion: Polysomnographic findings of patients with LSC demonstrated that sleep structure is disturbed by arousals and awakenings related to scratching bouts during sleep.


Key Points


* Repeated rubbing and scratching episodes are characteristic features of lichen simplex chronicus (LSC).


* It is important to determine whether scratching bouts during sleep in patients with LSC cause an abnormal sleep pattern.

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