Review
Factors affecting sleep quality in patients with psoriasis

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Poor sleep quality adversely affects quality of life in patients with psoriasis. However, the factors impairing sleep in these patients have not been well described. We reviewed the available literature linking sleep quality and psoriasis to elucidate factors that interfere with sleep. Pruritus, depression, pain, and obstructive sleep apnea may be likely sources of sleep impairment in patients with psoriasis. Fatigue resulting from sleep interference may also be implicated in this relationship. Pruritus, depression, and pain interfere with sleep quality by increasing nocturnal awakenings and sleep fragmentation. Obstructive sleep apnea may occur in a greater percentage of patients with psoriasis than control populations. Factors associated with psoriasis appear to have similarities in their cytokine and neuropeptide profiles. Moreover, these variables are complex and interconnected. Further study and awareness of potential factors impacting sleep in patients with psoriasis may provide new avenues for treatment of recalcitrant disease.

Section snippets

Methods

A PubMed literature search was performed in English that examined relationships between sleep quality and psoriasis using the terms “psoriasis” and “sleep.” Exclusion criteria included articles in text other than English, sleep as a medication adverse effect, quality-of-life instrument validation studies, and sleep in association with diseases other than psoriasis. Results obtained from this search revealed quality of life, pruritus, pain, depression, and sleep disorders as topics associated

Quality of life

Extensive study on quality of life in patients with psoriasis demonstrates a major impact on physical, psychologic, and social aspects of living. The use of generic, dermatologic, and psoriasis-specific quality-of-life instruments has aided in uncovering and identifying these extracutaneous manifestations of disease. The effects of psoriasis on sleep quality, however, have not been included in many of these assessments. Review of specific measures used to evaluate quality of life in patients

Discussion

Direct and indirect evidence demonstrates that sleep quality in patients with psoriasis can be adversely affected by pruritus, depression, pain, OSA, or a combination of these. Sleep difficulties caused by the association and potential overlap of these factors in patients may be attributed to similarities in cytokine and neuropeptide profiles that may act to alter sleep physiology. TNF, interleukin (IL)-6, and SP are mediators involved in psoriasis, pruritus, depression, pain, and OSA that may

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      Citation Excerpt :

      Furthermore, persistent sleep disturbance may exacerbate the severity of psoriasis, and psoriasis patients with disturbed sleep cycles are at higher risk of multiple comorbidities, including hypertension, stroke, insulin resistance and diabetes. Several factors such as pruritus, depression, pain, hypoxia and fatigue have been elucidated for deterioration of sleep quality and quantity or deprived sleep in psoriasis patients [289]. Obstructive sleep apnea (OSA) is an insidious clinical phenomenon represented by nocturnal awakenings and fitful slumber as a result of recurrent upper respiratory impediment during sleep.

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    Funding for manuscript development was provided by Abbott Laboratories. The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories, LP.

    Disclosure: Dr Goldblum is an employee of Abbott Laboratories and owns Abbott stock. Dr McCall has served as an investigator for GlaxoSmithKline, Mini Mitter, the National Institutes of Health, Sanofi-Aventis, Sealy, Sepracor, and Somaxon, receiving research grants; has served as a consultant for AstraZeneca, Orexo AB, Sepracor, and Somaxon, receiving honoraria; and has served as a member of the speakers' bureaus for Sanofi-Aventis and Sepracor, receiving honoraria. Dr Feldman has served as an advisory board member, investigator, and speaker for Abbott Laboratories, Astellas, Galderma, Steifel, and Warner Chilcott, receiving grants and honoraria; has served on the advisory board for Photomedex, receiving stock options; has been an investigator and speaker for Amgen, Centocor, and Genentech, receiving grants and honoraria; and has served as an advisory board member and speaker for the National Psoriasis Foundation, receiving honoraria. Ms Gowda has no conflicts to declare.

    Reprints not available from the author.

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