Psoriasis Disease Activity Linked to Specific Sleep Dysfunction
Key Takeaways
- PASI 10 or higher was associated with worse sleep latency and greater daytime dysfunction than lower disease activity.
- Global PSQI scores did not significantly differ between the severity groups, indicating a domain-specific pattern.
- Adjusted analyses showed the same direction of association, and the authors viewed sleep domains as more informative than the composite score in this dataset.
Researchers evaluated 136 consecutive adults with psoriasis from real-life cohorts in Trieste and Rome, Italy, between January 2021 and July 2021. All participants were Caucasian, 69.2% were male, and the median age was 58 years, with an interquartile range of 49 to 69. Disease severity was measured with PASI, sleep quality with the Pittsburgh Sleep Quality Index for global and component outcomes, quality of life with SF-36, and functional disability with HAQ. Patients were stratified by PASI below 10 versus PASI 10 or higher, and median PASI was 2 with an IQR of 1 to 4.5, reflecting predominantly low disease activity. Median global PSQI was 5 with an IQR of 3 to 8, which the authors characterized as borderline sleep impairment.
In unadjusted comparisons, patients with PASI 10 or higher had worse sleep latency and greater daytime dysfunction, with p values of 0.01 and 0.02, respectively. Global PSQI scores did not significantly differ between the severity strata. After adjustment for age, sex, disease duration, body mass index, and SF-36 physical and mental component summaries, sleep latency and daytime dysfunction remained associated with PASI 10 or higher. For sleep latency, beta was 0.95 with a 95% CI of 0.08 to 1.82 and p = 0.032. For daytime dysfunction, beta was 2.52 with a 95% CI of 1.31 to 3.73 and p < 0.001.
The authors viewed the pattern as a closer link between psoriasis activity and selected PSQI domains than with the composite PSQI score. In this cohort, they viewed domain-level sleep outcomes as more informative than global sleep quality alone within the variables measured. Sleep outcomes also fit within a broader patient-centered and holistic perspective, although the study did not test whether any intervention changes those domains.
Limitations included the cross-sectional design, which precludes causal inference, a relatively limited sample size, and a retrospective definition of disease remission that may have introduced misclassification.
Overall, the findings were limited to observed associations in specific sleep domains within a single observational cohort.