Sleep Quality in Psoriasis Patients and Its Relations with Possible Affecting Factors

Abstract

Objectives: Psoriasis (PS) is a chronic, immune-mediated inflammatory skin disease. PS may lead to significant effects on healthrelated quality of life (HRQoL) and other outcomes. In the present study, an investigation into sleep quality (SQ), and its possible relations with factors which may affect SQ were aimed. Methods: A total of 74 subjects from both sexes were enrolled in this study, between January and July 2017. Patients were evaluated with their demographics, body mass index (BMI), Psoriasis Area Severity Index (PASI), Pittsburgh Sleep Quality Index (PSQI), Psoriasis Quality of Life Index (PQLI), Self Perception Scale (SPS). Additionally, accompanying chronic diseases, disease duration and severity of pruritus were recorded. Obtained PSQI values were compared with the mentioned parameters concerning the significance of their relations with it. SPSS version 24, 2016 was used to analyse the data, and significance was evaluated with p-values of <0.05, 0.01, and 0.001, and rho (r) values of <0.2, =0.2-0.4, =0.4-0.6, =0.6-0.8 and >0.8. Results: Thirty-seven female and 37 male were studied. The mean age of total of the study population was 47.21±13.91. Mean BMI and mean duration were 30.09± 4.68 kg/m 2 , and 10.58±9.1 months. Mean values of PASI, PSQI, SPS, and PQLI of the study group were 19. 79±16.99, 9.14±5.09, 142.12±23.83, and 21.94±16.31, respectively. Approximately thirty-one percent of them had at least one chronic disease. Alcohol and smoking rates were 17.56%, 50%. PASI was positive/strongly correlated with PQLI and negative/ weakly correlated with SPS. No correlation was detected between PSQI values and age, gender, BMI, and SPS values. PSQI was moderately correlated with PQLI, diabetes mellitus (DM), and pruritus severity, whereas it was weak correlated with PASI, hypertension (HT), thyroid diseases and disease duration. PASI and DM showed a predictive effect on SQ. Conclusion: SQ is affected by certain factors, such as QoL, disease severity, disease duration, pruritus severity, accompanying disorders, such as HT, DM and thyroid diseases, in which disease severity and DM have predictive effects on SQ in PS patients. Controls of disease activation and prevention of progression in DM may provide to keep SQ in PS.

The Assessment of Risk and Predictors of Sleep Disorders in Patients with Psoriasis—A Questionnaire-Based Cross-Sectional Analysis

“…Literature data concerning these results are not consistent. In a study conducted by Tas et al outcomes similar to ours were observed—PSQI is not correlated with BMI in psoriatics [ 41 ]. In other research, but not concerning psoriatics, some authors suggest that such a relationship exists [ 42 ], whereas some only noted such a relationship in women [ 43 ].…”

Nocturnal pruritus and sleep disturbance associated with dermatologic disorders in adult patients

“…2020 ; Henry et al., 2017 ; Jensen et al., 2018 ; Kimball et al., 2016 ; Ljossa et al., 2012 ; Shutty et al., 2013 ; Smith et al. 2019 ; Tas et al., 2020 ; Wu at al., 2008 ; Zachariae et al., 2012 ) SD in 39%-82% of pts; ↓ SQ, ↑ SL, ↓ sleep duration/efficiency, ↑ premature sleep awakening, trouble sleeping due to being too hot and experiencing pain; ↑ daytime somnolence; ↓ QoL Disorder of thermoregulation and heat loss mechanism leading to ↑ CBT (↓ CBT necessary for sleep initiation); ↓ itch threshold leading to NP; multiple factors affect sleep including pruritus, disease severity, obesity, OSAHS, smoking, comorbid conditions (especially depression), cognitive and somatic arousal SD showed positive correlation with itch and PASI scores; etanercept ( Mrowietz et al., 2015 ), adalimumab ( Strober et al., 2012 ), and betamethasone dipropionate/calcipotriol ( Jalili et al., 2019 ; Kontochristopoulos et al., 2016 ) treatments ↑ SQ; psoriasis not a/w SD in 1 study ( Stinco et al., 2013 ) Hidradenitis suppurativa ( Kaaz et al., 2018 ; Vossen at al., 2017 ) SD in 70.4% of pts; ↓ sleep duration, ↑ SL, habitual sleep efficiency; daytime dysfunction Itch and pain a/w SD; activation of Th17 and Th2 pathways serum level of pruritogenic cytokines; itch and pain have an important impact on insomnia and SQ Often a/w anxiety, fatigue, depression and stigmatization; pain is a crucial factor in SD Chronic spontaneous urticaria ( Abdel, 2017 ) SD in 48.8% of pts; ↑ sleep latency, ↓ sleep duration, ↑ daytime somnolence Release of histamine, substance P, and CGRP, which ↑ NP and affect SQ Urticaria severity score – 7 items is proportional to degree of SD; omalizumab treatment may improve SQ ( Gimenez et al., 2016 ) Infestations (e.g., scabies) ( Worth et al., 2012 ) SD in 87.5% of pts; ↓ SQ, ↓ sleep duration, ↑ premature awakenings Scabies mites more active at night; feces (scybala) activate protease activating receptor-2 (pruritic receptor); Th2 immunity against mite results in production of potent pruritogens, such as IL-31 Only cause of NP with acute onset and short duration; SD improves promptly with ivermectin treatment a/w, associated with; CBT, core body temperature; CGRP, calcitonin gene ...…”

Sleep Disorders and Psoriasis: An Update

“…Severity of psoriasis. Several studies have found that the clinical severity of psoriasis is associated with an increased risk of developing SDs (26,33,(49)(50)(51)(52). A study by Melikoglu et al of 48 psoriatic patients showed that PSQI scores were significantly correlated with psoriasis severity assessed by the Psoriasis Area and Severity Index (PASI) (p = 0.03) (33).…”