Daniela Adamo1, Elena Calabria1, Noemi Coppola1, Lorenzo Lo Muzio2, Michele Giuliani2, Lorenzo Azzi3, Vittorio Maurino3, Giuseppe Colella4, Raffaele Rauso4, Lucio Montebugnoli5, Davide Bartolomeo Gissi5, Mario Gabriele6, Marco Nisi6, Andrea Sardella7, Giovanni Lodi7, Elena Maria Varoni7, Amerigo Giudice8, Alessandro Antonelli8, Marco Cabras9, Alessio Gambino9, Paolo Vescovi10, Alessandra Majorana11, Elena Bardellini11, Giuseppina Campisi12, Vera Panzarella12, Francesco Spadari13, Sonia Marino13, Monica Pentenero14, Samuele Sutera14, Matteo Biasotto15, Margherita Gobbo15,16, Luca Guarda Nardini16, Umberto Romeo17, Gianluca Tenore17, Rosario Serpico4, Alberta Lucchese4, Carlo Lajolo18, Cosimo Rupe18, Massimo Aria19, Agostino Gnasso19, Michele Davide Mignogna1. 1. Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy. 2. Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy. 3. Department of Medicine and Surgery, Unit of Oral Medicine and Pathology, ASST dei Sette Laghi, University of Insubria, Varese, Italy. 4. Multidisciplinary Department of Medical, Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy. 5. Department of Biomedical and Neuromotor Sciences, Section of Oral Sciences, University of Bologna, Bologna, Italy. 6. Department of Surgical Pathology, Medicine, Molecular and Critical Area, University of Pisa, Pisa, Italy. 7. Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy. 8. Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy. 9. Oral Medicine Section, Department of Surgical Science, CIR Dental School, University of Turin, Turin, Italy. 10. Department of Medicine and Surgery, Oral Medicine and Laser Surgery Unit, University Center of Dentistry, University of Parma, Parma, Italy. 11. Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy. 12. Department of Surgical, Oncological, and Oral Sciences, University of Palermo, Palermo, Italy. 13. Department of Biomedical, Surgical and Dental Sciences, Maxillo-facial and Dental Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico. University of Milan, Milan, Italy. 14. Department of Oncology, Oral Medicine and Oral Oncology Unit, University of Turin, Turin, Italy. 15. Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy. 16. Unit of Oral and Maxillofacial Surgery, Ca' Foncello Hospital, Treviso, Italy. 17. Department of Oral Sciences and Maxillofacial Surgery, University of Rome La Sapienza, Rome, Italy. 18. Head and Neck Department, School of Dentistry, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy. 19. Department of Economics and Statistics, University Federico II of Naples, Naples, Italy.
Abstract
BACKGROUND: The wellbeing of oral lichen planus patients (OLPs) may be strongly influenced by a poor quality of sleep (QoS) and psychological impairment. The aims were to analyze the prevalence of sleep disturbance, anxiety, and depression in OLPs and to validate the Pittsburgh Sleep Quality Index (PSQI) in OLPs. METHODS: Three hundred keratotic OLPs (K-OLPs), 300 with predominant non-keratotic OLP (nK-OLPs), and 300 controls were recruited in 15 Italian universities. The PSQI, Epworth Sleepiness Scale (ESS), Hamilton Rating Scales for Depression and Anxiety (HAM-D and HAM-A), Numeric Rating Scale (NRS), and Total Pain Rating Index (T-PRI) were administered. RESULTS: Oral lichen planus patients had statistically higher scores than the controls in the majority of the PSQI sub-items (p-values < 0.001**). Moreover, OLPs had higher scores in the HAM-D, HAM-A, NRS, and T-PRI (p-values < 0.001**). No differences in the PSQI sub-items' scores were found between the K-OLPs and nK-OLPs, although nK-OLPs suffered from higher levels of anxiety, depression, and pain (p-values: HAM-A, 0.007**, HAM-D, 0.009**, NRS, <0.001**, T-PRI, <0.001**). The female gender, anxiety, depression (p-value: 0.007**, 0.001**, 0.020*) and the intensity of pain, anxiety, and depression (p-value: 0.006**, <0.001**, 0.014*) were independent predictors of poor sleep (PSQI > 5) in K-OLPs and nK-OLPs, respectively. The PSQI's validation demonstrated good internal consistency and reliability of both the total and subscale of the PSQI. CONCLUSIONS: The OLPs reported an overall impaired QoS, which seemed to be an independent parameter according to the regression analysis. Hence, clinicians should assess QoS in OLPs and treat sleep disturbances in order to improve OLPs management.
BACKGROUND: The wellbeing of oral lichen planus patients (OLPs) may be strongly influenced by a poor quality of sleep (QoS) and psychological impairment. The aims were to analyze the prevalence of sleep disturbance, anxiety, and depression in OLPs and to validate the Pittsburgh Sleep Quality Index (PSQI) in OLPs. METHODS: Three hundred keratotic OLPs (K-OLPs), 300 with predominant non-keratotic OLP (nK-OLPs), and 300 controls were recruited in 15 Italian universities. The PSQI, Epworth Sleepiness Scale (ESS), Hamilton Rating Scales for Depression and Anxiety (HAM-D and HAM-A), Numeric Rating Scale (NRS), and Total Pain Rating Index (T-PRI) were administered. RESULTS: Oral lichen planus patients had statistically higher scores than the controls in the majority of the PSQI sub-items (p-values < 0.001**). Moreover, OLPs had higher scores in the HAM-D, HAM-A, NRS, and T-PRI (p-values < 0.001**). No differences in the PSQI sub-items' scores were found between the K-OLPs and nK-OLPs, although nK-OLPs suffered from higher levels of anxiety, depression, and pain (p-values: HAM-A, 0.007**, HAM-D, 0.009**, NRS, <0.001**, T-PRI, <0.001**). The female gender, anxiety, depression (p-value: 0.007**, 0.001**, 0.020*) and the intensity of pain, anxiety, and depression (p-value: 0.006**, <0.001**, 0.014*) were independent predictors of poor sleep (PSQI > 5) in K-OLPs and nK-OLPs, respectively. The PSQI's validation demonstrated good internal consistency and reliability of both the total and subscale of the PSQI. CONCLUSIONS: The OLPs reported an overall impaired QoS, which seemed to be an independent parameter according to the regression analysis. Hence, clinicians should assess QoS in OLPs and treat sleep disturbances in order to improve OLPs management.