Psoriatic Insomnia: A Subjective and Objective Sleep Evaluation
DOI:
https://doi.org/10.2340/actadv.v103.4507Keywords:
actigraphy, insomnia, itching, pruritus, psoriasis, sleep, treatmentAbstract
Psoriasis may affect patients’ sleep. In order to examine this relationship, this study evaluated non-anxious and non-depressive patients with moderate to severe psoriasis before and after 6 months of systemic treatment. A prospective case-control study with 46 consecutive patients (mean age 51.1 ± 12.8 years, 18 women) and 24 age-, sex- and body mass index-matched controls (mean age 46.5 ± 15.4 years, 12 women) was conducted to assess sleep using both sleep questionnaires and actigraphy. Of psoriatic patients, 91.3% were poor sleepers, and 65.2% of the psoriatic patients presented insomnia symptoms, compared with 54.2% and 33.3% of the control group (p < 0.001, p = 0.02, respectively). Actigraphy showed that Total Sleep Time was shorter in patients, while 82.6% of the psoriatic patients had poor Sleep Efficiency, compared with controls (p = 0.004, p = 0.03, respectively). Patients’ quality of life was associated with sleep disturbance (p < 0.001), and pruritus was negatively correlated with sleep duration (p < 0.001). After 6 months of treatment, patients’ sleep pattern, according to actigraphy, had not changed significantly; however, they had insomnia for no longer than the control group (p = 0.65), whereas the above-mentioned correlations were non-significant after treatment. Psoriatic insomnia was improved after 6 months of systemic treatment. Actigraphy may be used as an objective tool to evaluate sleep in these patients.
Downloads
References
Griffiths CE, Barker JN. Pathogenesis and clinical features of psoriasis. Lancet 2007; 370: 263-271.
https://doi.org/10.1016/S0140-6736(07)61128-3
Mrowietz U, Kragballe K, Reich K, Spuls P, Griffiths C.E.M, Nast A, et al. Definition of treatment goals for moderate to severe psoriasis: a European consensus. Arch Dermatol Res 2011; 303: 1-10.
https://doi.org/10.1007/s00403-010-1080-1
Smith MP, Ly K, Thibodeaux Q, Weerasinghe T, Beck K, Shankle L, et al. Factors influencing sleep difficulty and sleep quantity in the Citizen Pscientist Psoriatic Cohort. Dermatol Ther 2019; 9: 511-523.
https://doi.org/10.1007/s13555-019-0306-1
Thorburn PT, Riha RL. Skin disorders and sleep in adults: where is the evidence? Sleep Med Rev 2010; 14: 351-358.
https://doi.org/10.1016/j.smrv.2009.12.001
Irwin, MR. Why sleep is important for health: a psychoneuroimmunology perspective. Annu Rev Psychol 2015; 3: 143-172.
https://doi.org/10.1146/annurev-psych-010213-115205
Irwin MR, Olmstead R, Carroll JE. Sleep disturbance, sleep duration, and inflammation: a systematic review and meta-analysis of cohort studies and experimental sleep deprivation. Biol Psychiatry 2016; 80: 40-52.
https://doi.org/10.1016/j.biopsych.2015.05.014
Dalamaga M, Papadavid E, Vlami K. Unmasking the Janus face of the association between psoriasis, metabolic syndrome and obstructive sleep apnea. Sleep Breath 2013; 17: 449-450.
https://doi.org/10.1007/s11325-012-0749-4
Papadavid E, Vlami K, Dalamaga M, Giatrakou S, Theodoropoulos K, Gyftopoulos S, et al. Sleep apnea as a comorbidity in obese psoriasis patients: a cross-sectional study. Do psoriasis characteristics and metabolic parameters play a role? J Eur Acad Dermatol Venereol 2013; 27: 820-826.
https://doi.org/10.1111/j.1468-3083.2012.04580.x
Papadavid E, Dalamaga M, Vlami K, Koumaki D, Gyftopoulos S, Christodoulatos GS, et al. Psoriasis is associated with risk of obstructive sleep apnea independently from metabolic parameters and other comorbidities: a large hospital-based case control study. Sleep Breath 2017; 21: 949-958.
https://doi.org/10.1007/s11325-017-1507-4
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. Br J Dermatol 2017; 177: 1052-1059.
https://doi.org/10.1111/bjd.15469
Jensen P, Zachariae C, Skov L, Zachariae R. Sleep disturbance in psoriasis - a case-controlled study. Br J Dermatol 2018; 179: 1376-1384.
https://doi.org/10.1111/bjd.16702
Henry AL, Chisholm A, Carter LA, Bundy C, Griffiths CEM, Kyle SD. The relationship between sleep disturbance, symptoms and daytime functioning in psoriasis: a prospective study integrating actigraphy and experience sampling methodology. Sleep Medicine 2020; 72: 144-149.
https://doi.org/10.1016/j.sleep.2020.03.013
Buysse DJ, Reynolds 3rd CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1988; 28: 193-213.
https://doi.org/10.1016/0165-1781(89)90047-4
Perantoni E, Steiropoulos P, Siopi D, Amfilochiou A, Michailidis V, Christoforatou K, et al. Validation of the Greek version of Pittsburg sleep quality questionnaire in a sleep lab population. Eur Respir J 2012; 40: P903.
Soldatos CR, Dikeos DG, Paparrigopoulos TJ. Athens Insomnia Scale: validation of an instrument based on ICD-10 criteria. J Psychosom Res 2000; 48: 555-560.
https://doi.org/10.1016/S0022-3999(00)00095-7
Soldatos CR, Dikeos DG, Paparrigopoulos TJ. The diagnostic validity of the Athens Insomnia Scale. J Psychos Res 2003; 55: 263-267.
https://doi.org/10.1016/S0022-3999(02)00604-9
Johns MW. Daytime sleepiness, snoring and obstructive sleep apnea. The Epworth Sleepiness Scale. Chest 1993; 103: 30-36.
https://doi.org/10.1378/chest.103.1.30
Tsara V, Serasli E, Amfilochiou A, Constantinidis T, Christaki P. Greek version of the Epworth Sleepiness Scale. Sleep Breath 2004; 8: 91-95.
https://doi.org/10.1055/s-2004-829632
Marino M, Yi Li, Rueschman NM, Wilkelman JW, Ellenbogen JM, Solet JM, et al. Measuring sleep: accuracy, sensitivity, and specificity of wrist actigraphy compared to polysomnography. Sleep 2013; 36: 1747-1755.
https://doi.org/10.5665/sleep.3142
Zachariae R, Zachariae COC, Lei U, Pedersen AF. Affective and sensory dimensions of pruritus severity: associations with psychological symptoms and quality of life in psoriasis patients. Acta Derm Venereol 2008; 88: 121-127.
https://doi.org/10.2340/00015555-0371
Yosipovitch G, Goon A, Wee J, Chan YH, Goh CL. The prevalence and clinical characteristics of pruritus among patients with extensive psoriasis. Br J Dermatol 2000; 143: 969-973.
https://doi.org/10.1046/j.1365-2133.2000.03829.x
Hirotsu C, Rydlewski M, Araújo MS, Tufik S, Andersen ML. Sleep loss and cytokines levels in an experimental model of psoriasis. PLoS One 2012; 7: e5118.
https://doi.org/10.1371/journal.pone.0051183
Moynihan J, Rieder E, Tausk F. Psychoneuroimmunology: the example of psoriasis. J Ital Dermatol Venereol 2010; 145: 221-228.
Covassin N, Singh P. Sleep duration and cardiovascular disease risk: epidemiologic and experimental evidence. Sleep Med Clin 2016; 11: 81-89.
https://doi.org/10.1016/j.jsmc.2015.10.007
Seow LSE, Tan XW, Chong SA, Vaingankar JA, Abdim E, Shafie S, et al. Independent and combined associations of sleep duration and sleep quality with common physical and mental disorders: results from a multi-ethnic population-based study. PLoS One 2020; 15: 1-17.
https://doi.org/10.1371/journal.pone.0235816
Shutty BG, West C, Huang KE, Landis E, Dabade T, Browder B, et al. Sleep disturbances in psoriasis. Dermatol Online J 2013; 19: 1.
https://doi.org/10.5070/D30073R324
Riemann D, Voderholzer U. Primary insomnia: a risk factor to develop depression? J Affect Disord 2003; 76: 255-259.
https://doi.org/10.1016/S0165-0327(02)00072-1
Dag Neckelmann. Chronic insomnia as a risk factor for developing anxiety and depression. Sleep 2007; 30: 873-880.
https://doi.org/10.1093/sleep/30.7.873
Fernandez-Mendoza J, Baker JH, Vgontzas AN, Gaines J, Liao D, Bixler EO. Insomnia symptoms with objective short sleep duration are associated with systemic inflammation in adolescents. Brain Behav Immun 2017; 61: 110-116.
https://doi.org/10.1016/j.bbi.2016.12.026
Berk M, Williams LJ, Jacka FN, O'Neil A, Pasco J.A, Moylan S, et al. So depression is an inflammatory disease, but where does the inflammation come from? BMC Med 2013; 11: 200.
https://doi.org/10.1186/1741-7015-11-200
Irwin MR, Piber D. Insomnia and inflammation: a two hit model of depression risk and prevention. World Psychiatry 2018; 17: 359-361.
https://doi.org/10.1002/wps.20556
Buysse DJ. Insomnia. JAMA 2013; 309: 706-716.
https://doi.org/10.1001/jama.2013.193
Singh S, Taylor C, Kornmehl H, Armstrong A.W. Psoriasis and suicidality: a systematic review and meta-analysis. J Am Acad Dermatol 2017; 77: 425-440.
https://doi.org/10.1016/j.jaad.2017.05.019
Camela E, Potestio L, Fabbrocini G, Ruggiero A, Megna M. New frontiers in personalized medicine in psoriasis. Expert Opin Biol Ther 2022; 16: 1-3.
https://doi.org/10.2147/PTT.S328460
Wu C-Y, Chang Y-T, Juan C-K, Shen J-L, Lin Y-P, Shieh J-J, et al. Depression and insomnia in patients with psoriasis and psoriatic arthritis taking tumor necrosis factor antagonists. Medicine 2016; 95: e3816.
https://doi.org/10.1097/MD.0000000000003816
Zamarrón C, Maceiras F, Mera A, Gomez-Reino JJ. Effect of the first infliximab infusion on sleep and alertness in patients with active rheumatoid arthritis. Ann Rheum Dis 2004; 63: 88-90.
https://doi.org/10.1136/ard.2003.007831
Strober BE, Sobell JM, Duffin KC, Bao Y, Guerin A, Yang H, et al. Sleep quality and other patient-reported outcomes improve after patients with psoriasis with suboptimal response to other systemic therapies are switched to adalimumab: results from PROGRESS, an open-label Phase IIIB trial. Br J Dermatol 2012; 167: 1374-1381.
https://doi.org/10.1111/bjd.12000
Thaci D, Galimberti R, Guerra MA, Rosenbach T, Robertson D, Pedersen R, et al. Improvement in aspects of sleep with etanercept and optional adjunctive topical therapy in patients with moderate-to-severe psoriasis: results from the PRISTINE trial. J Eur Acad Dermatol Venereol 2014; 28: 900-906.
https://doi.org/10.1111/jdv.12207
Radi G, Campanati A, Diotallevi F, Rizzetto G, Martina E, Bobyr I, et al. Long-term efficacy and safety of apremilast in the treatment of plaques psoriasis: a real-world, single-center experience. Dermatol Ther 2021; 34: e15179.
https://doi.org/10.1111/dth.15179
Kapniari E, Dalamaga M, Papadavid E. Comorbidities burden and previous exposure to biological agents may predict drug survival of apremilast for psoriasis in a real-world setting. Dermatol Ther 2020; 33: e14168.
Published
How to Cite
License
Copyright (c) 2023 Katerina Vlami, Kleoniki Pantelidi, Maria Dalamaga, Fani Karagianni, Konstantinos Theodoropoulos, Spyridon Papiris, Evangelia Papadavid
![Creative Commons License](http://i.creativecommons.org/l/by-nc/4.0/88x31.png)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All digitalized ActaDV contents is available freely online. The Society for Publication of Acta Dermato-Venereologica owns the copyright for all material published until volume 88 (2008) and as from volume 89 (2009) the journal has been published fully Open Access, meaning the authors retain copyright to their work.
Unless otherwise specified, all Open Access articles are published under CC-BY-NC licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.