Sleep apnea and psoriasis: A cohort study

Introduction: Psoriasis is a multigenic inflammatory skin disease associated with hypergrowth of keratinocytes and causes lesions known as plaques, with painful skin and/or psoriatic arthritis; it was associated with metabolic impairment, cardiovascular diseases and obstructive sleep apneas (OSAS), both linked with sistemic inflammation. Mean age at onset is 28 years, and it was estimated in Italy about 1.000.000 people affected. Method: All psoriasis patients in Vercelli Hospital were asked for sleep disorders and stimulated to meet sleep medicine experts for polysomnographic screening. The PASI (Psoriasis Area and Severity Index) was applied to exstimate psoriasis severity, the DLQI (Dermatology Life Quality Index, range 0–30) to describe the effect of psoriasis on patients quality of life, recording all psoriasis drugs (IL-17 and IL-23 inhibitors). We identified 37 psoriasis patients affected by OSAS (AASM criteria for OSAS diagnosis were applied), and checked their PASI scores and DLQI but also Insomnia, Depression and Quality sleep scales, serum CRP levels, ESS, AHI at time of OSA diagnosis and after a 5-years treatment follow-up. Results: The majority were males, with cardiovascular comorbidities (76%), insomnia or sleepiness at diagnosis (81%) and moderate to severe apnea hypopnea index (>15). We investigated the effects of positive airway pressure (PAP) and in some case MAD therapy on both diseases in a 5 years follow-up period with multidisciplinar evaluations (polysomnography, serum CRP, Psoriasis Area Severity Index, Dermatology Life Quality Index). Conclusion: Our data support the hypothesis of an improvement of skin lesions and life quality (scales p < 0.001) associated with (PAP or MAD) OSA therapy and suggest to investigate sleep disorders in psoriasis group. References: Hu, S. et al. Psoriasis and Cardiovascular Comorbidities. Int. J. Mol. Sci. (2017); Ger, T. et al. Bidirectional Association Between Psoriasis and OSA: A Systematic Review MetaAnalysis. Sci. Rep. (2020).