الفهرس 
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Abstract
Urticaria is one of the most frequent presenting complaints in dermatology, allergy and emergency departments. CU symptoms affect a wide range of daily activities, work performance and social relationships.
Urticaria is classified as acute (up to 6 weeks) or chronic (beyond 6 weeks of clinical course). chronic urticaria (CU) is defined by recurrent episodes occurring at least twice a week for 6 weeks. It affects 15-20% of the population once or more during a life time.
The aim of study was to assess the impact of CSU on quality of sleep, the levels of depression, anxiety, and quality of life (QOL) as well as their interaction with each other and their relation to disease related factors.
This study was carried out at the outpatient clinic of Dermatology, Venereology and Andrology, Assiut university hospital and Sohag Dermatology Clinic (Ministry of health). The study included 25 patients with CU and 25 healthy controls.
Urticaria Activity Score 7 (UAS7) was used for objective evaluation of the intensity of urticaria. Daily UAS scores are summed over 7 consecutive days to create the UAS7. Patients completed a 10-cm visual analogue score (VAS) indicating the overall severity of their itching over the previous 2 weeks from 0 (none) to 10 (severe itching).
The Dermatology Life Quality Index (DLQI) was used to evaluate quality of life. Patients were also assessed for anxiety and depression with the Hospital Anxiety and Depression Scale (HADS). Pittsburgh Sleep Quality Index (PSQI) was used for measuring subjective sleep quality and sleep disturbances.
There was no significant difference with respect to sociodemographic characteristics between the groups of patient and healthy control in this study.
All patients had severe urticaria with a mean UAS7 score 39.72±2.76, mean VAS score 28±1.34 and mean DLQI score 24.8±4.37 indicating severe impact on quality of life.
We found that patients with chronic urticaria had higher HADS-depression, HADS- anxiety and total HADS scores when compared to controls, 72% of patients were found to be depressed and 92% had anxiety.
Using PSQI questionnaire, patients with CU had significantly longer sleep latency onset, shorter total sleep duration, lower sleep efficiency and higher PSQI scores compared to controls. Also, patients were more severely affected in the domains of sleep disturbance, quality and latency, habitual sleep efficiency and daytime dysfunction.
There was no influence of age, gender, marital status, disease duration or presence of angioedema on depression or anxiety in CU patients. Also there was no significant correlation between age or disease duration and QOL, depression and anxiety scores in our study.
QOL was unrelated to levels of depression or anxiety. However, DLQI correlated with both VAS and UAS7 scores. There was a correlation between HADS-A and HADS-D scores. Also, both anxiety and depression scores correlated with itching severity assessed by VAS scores. However, the UAS-7 did not show correlation with depression or anxiety scores.
Older age and female gender were associated with poorer sleep efficiency. In addition, the severity of urticarial symptoms assessed with VAS and UAS7 scores significantly correlated with poor sleep quality assessed by PSQI scores.
Our results also indicated that the levels of anxiety (HADS-A scores) significantly correlated with poor sleep quality.