Sleep disturbance in psoriasis leads to psychological and physical predictors

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Both poor sleep and a high likelihood of obstructive sleep apnea were associated with more severe psoriasis.
Both poor sleep and a high likelihood of obstructive sleep apnea were associated with more severe psoriasis.

Findings of a cross-sectional online survey published in the British Journal of Dermatology suggest that sleep disturbance, which is quite common among people with psoriasis, is associated with a host of psychological and physical factors. The rate of probable obstructive sleep apnea (OSA) in these patients was also high.

The relationship between sleep disturbance and psoriasis has been the focus of much research. In this survey, researchers sought to characterize sleep disturbance in patients with psoriasis and to identify physical and psychological predictors of sleep quality in this population.

The online survey, which was completed by 186 respondents (mean age, 39.2 years), included the following validated measures: (1) Pittsburgh Sleep Quality Index (PSQI), which assessed sleep quality and disturbance over 1 month; (2) Berlin Questionnaire, which assessed an individual's risk for OSA developing; (3) Morningness-Eveningness Questionnaire (MEQ), which established a respondent's chronotype (ie, propensity to sleep at a particular time during a 24-hour period); (4) Pre-Sleep Arousal Scale, which quantifies cognitive and somatic arousal during the presleep period; (5) Hospital Anxiety and Depression Scale (HADS), an established measure of a person's mood; (6) Simplified Psoriasis Index-Severity (SPI-S), which is a self-assessment of psoriasis severity; and (7) 5-D Itch Scale, which assesses the severity and impact of an individual's itch.

The PSQI includes 19 items that are scored across 7 components, generating a global score that ranges from 0 to 21, with a score ≤5 indicating normal sleep and a score ≥6 denoting poor sleep.

The mean PSQI score of the respondents was 9.2, with 76.3% scoring above the threshold for poor sleep. Of the 186 participants, 61 (32.8%) had a high probability of OSA based on results of the Berlin Questionnaire.

Both poor sleep and a high likelihood of OSA were associated with more severe psoriasis (P <.05). Cognitive arousal (P =.001), itch (P <.001), and depression (P =.001) were the most significant predictors of poor sleep quality, and along with somatic arousal (P =.022), accounted for 43% of the variation in PSQI scores.

The researchers concluded that sleep complaints among individuals with psoriasis warrant greater clinical attention.

Reference

Henry AL, Kyle SD, Chisholm A, Griffiths CEM, Bundy C. A cross-sectional survey of the nature and correlates of sleep disturbance in people with psoriasis [published online March 17, 2017]. Br J Dermatol. doi:10.1111/bjd.15469

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