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Wu Y, Chen Z, Cheng Z, Yu Z, Qin K, Jiang C, Xu J. Effects of chronic diseases on health related quality of life is mediated by sleep difficulty in middle aged and older adults. Sci Rep 2025; 15:2987. [PMID: 39849013 PMCID: PMC11758026 DOI: 10.1038/s41598-025-86420-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Accepted: 01/10/2025] [Indexed: 01/25/2025] Open
Abstract
Middle-aged and older adults with chronic diseases are more likely to encounter sleep difficulty and have a reduced Health-Related Quality of Life (HRQoL), but there is little research on their possible mechanisms. Therefore, the main objective of this study was to explore how sleep difficulty mediates the impact of chronic diseases on the HRQoL of middle-aged and older adults. The survey data were from a cross-sectional study carried out in 2019 in Hangzhou, China. We used a multi-stage cluster random sampling method to recruit participants from seven districts in Hangzhou. Multiple regression was used to analyze the relationship between chronic diseases, sleep difficulty and HRQoL. And the mediate package in the R language was used to analyze the mediating effect. A total of 3,550 middle-aged and older adults were enrolled, including 2,273 patients with chronic diseases and 1,277 patients without them. Patients with chronic diseases had lower health utility values (β=-0.0084, P < 0.01) and were more likely to suffer from sleep difficulty (β = 0.5737, P < 0.001). After correcting for demographic and life characteristics, the mediation analysis results indicated that sleep difficulty mediated the relationship between chronic diseases and HRQoL (β=-0.0022, 95% Bca CI: -0.0034 -0.0014). Additionally, sleep difficulty influenced the association between chronic diseases and daily activities as well as pain (or discomfort) (β = 0.0083, 95% Bca CI: 0.0042-0.0111; β = 0.0162, 95% Bca CI: 0.0107-0.0225) in the analysis of the dimensions. Sleep difficulty partially mediated the relationship between chronic diseases and HRQoL, and primarily in the daily activities and pain (or discomfort) dimensions in middle-aged and older adults.
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Affiliation(s)
- Yaoyao Wu
- Department of Chronic and Non-Communicable Disease, Hangzhou Center for Disease Control and Prevention (Hangzhou Health Supervision Institution), Hangzhou, Zhejiang Provinces, People's Republic of China
| | - Zesheng Chen
- Department of Chronic and Non-Communicable Disease, Hangzhou Center for Disease Control and Prevention (Hangzhou Health Supervision Institution), Hangzhou, Zhejiang Provinces, People's Republic of China
| | - Zongxue Cheng
- Department of Chronic and Non-Communicable Disease, Hangzhou Center for Disease Control and Prevention (Hangzhou Health Supervision Institution), Hangzhou, Zhejiang Provinces, People's Republic of China
| | - Zhecong Yu
- Department of Chronic and Non-Communicable Disease, Hangzhou Center for Disease Control and Prevention (Hangzhou Health Supervision Institution), Hangzhou, Zhejiang Provinces, People's Republic of China
| | - Kang Qin
- Department of Chronic and Non-Communicable Disease, Hangzhou Center for Disease Control and Prevention (Hangzhou Health Supervision Institution), Hangzhou, Zhejiang Provinces, People's Republic of China
| | - Caixia Jiang
- Department of Chronic and Non-Communicable Disease, Hangzhou Center for Disease Control and Prevention (Hangzhou Health Supervision Institution), Hangzhou, Zhejiang Provinces, People's Republic of China
| | - Jue Xu
- Department of Chronic and Non-Communicable Disease, Hangzhou Center for Disease Control and Prevention (Hangzhou Health Supervision Institution), Hangzhou, Zhejiang Provinces, People's Republic of China.
- Hangzhou Center for Disease Control and Prevention(Hangzhou Health Supervision Institution), 568 Ming-shi Rd, Hangzhou, 310021, Zhejiang, People's Republic of China.
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Wang Q, Wu Y, Wang X, Zhang J, Li L, Wu J, Lu Y, Han L. Genomic correlation, shared loci, and causal relationship between insomnia and psoriasis: a large-scale genome-wide cross-trait analysis. Arch Dermatol Res 2024; 316:425. [PMID: 38904754 DOI: 10.1007/s00403-024-03178-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/08/2024] [Accepted: 06/08/2024] [Indexed: 06/22/2024]
Abstract
Psoriasis and insomnia have co-morbidities, however, their common genetic basis is still unclear. We analyzed psoriasis and insomnia with summary statistics from genome-wide association studies. We first quantified overall genetic correlations, then ascertained multiple effector loci and expression-trait associations, and lastly, we analyzed the causal effects between psoriasis and insomnia. A prevalent genetic link between psoriasis and insomnia was found, four pleiotropic loci affecting psoriasis and insomnia were identified, and 154 genes were shared, indicating a genetic link between psoriasis and insomnia. Yet, there is no causal relationship between psoriasis and insomnia by two-sample Mendelian randomization. We discovered a genetic connection between insomnia and psoriasis driven by biological pleiotropy and unrelated to causation. Cross-trait analysis indicates a common genetic basis for psoriasis and insomnia. The results of this study highlight the importance of sleep management in the pathogenesis of psoriasis.
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Affiliation(s)
- Qing Wang
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Research Team of bio-molecular and system biology of Chinese medicine, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China
| | - Yuan Wu
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xuehua Wang
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Junhong Zhang
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Research Team of bio-molecular and system biology of Chinese medicine, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China
| | - Li Li
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Research Team of bio-molecular and system biology of Chinese medicine, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China
| | - Jingjing Wu
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China.
- Research Team of bio-molecular and system biology of Chinese medicine, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China.
| | - Yue Lu
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China.
- Research Team of bio-molecular and system biology of Chinese medicine, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China.
| | - Ling Han
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China.
- Research Team of bio-molecular and system biology of Chinese medicine, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China.
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3
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Spencer RK, Jin JQ, Elhage KG, Davis MS, Hakimi M, Gondo G, Liao W, Bhutani T. Association Between Poor Sleep and Myocardial Infarction in Patients with Psoriasis: Findings from a Cross-Sectional Study with the National Psoriasis Foundation. Dermatol Ther (Heidelb) 2023; 13:2903-2909. [PMID: 37798556 PMCID: PMC10613158 DOI: 10.1007/s13555-023-01045-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/15/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Poor sleep quality occurs in patients with psoriasis at rates nearly twice that of the general population. Chronic sleep impairment is an independent risk factor for the development of cardiovascular disease. Here, we examine the association between sleep quantity and history of myocardial infarction in patients with psoriasis. METHODS This observational, cross-sectional study utilized data from the 2020 National Psoriasis Foundation Annual Survey. Effect estimates were obtained using a multivariate logistic regression model, which controlled for prespecified covariates. RESULTS Based on data from 1405 individuals with psoriasis, our analysis demonstrated a significant association between sleep quantity and history of myocardial infarction: odds ratio (OR) 0.67 [95% confidence interval (CI) 0.49-0.92], p = 0.012. The association was not significantly influenced by psoriasis severity (OR 1.01, [95% CI 0.99-1.03], p = 0.38), comorbid psoriatic arthritis (OR 1.06, [95% CI 0.48-2.38], p = 0.88), sleep apnea, or other traditional risk factors for myocardial infarction. CONCLUSION Our analyses indicate an association between sleep quantity and history of myocardial infarction in patients with psoriasis. For each hour increase in average nightly sleep, patients with psoriasis have a 33% decrease in the odds of having a history of myocardial infarction. The chief limitation of this study is its cross-sectional design limiting ascertainment of causality.
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Affiliation(s)
- Riley K Spencer
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA.
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, USA.
| | - Joy Q Jin
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kareem G Elhage
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Mitchell S Davis
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Marwa Hakimi
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - George Gondo
- National Psoriasis Foundation, Portland, OR, USA
| | - Wilson Liao
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Tina Bhutani
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
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Grant C, Woodbury M, Skougaard M, Boldsen JK, Ogdie A, Klerman EB, Merola JF, Perez-Chada LM. Sleep Problems in Patients With Psoriatic Arthritis: A Systematic Literature Review and Metaanalysis. J Rheumatol 2023; 50:jrheum.2022-1169. [PMID: 37127321 PMCID: PMC10618413 DOI: 10.3899/jrheum.2022-1169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE The aim of this systematic review and metaanalysis is to summarize evidence regarding the relationship between psoriatic arthritis (PsA) and sleep problems. METHODS We identified 36 eligible studies-26 cross-sectional, 7 cohort, and 3 interventional studies-in PubMed and Embase. RESULTS The prevalence of self-reported sleep problems in patients with PsA ranged from 30% to 85%. A metaanalysis of 6 studies that used the Pittsburgh Sleep Quality Index revealed a prevalence of poor sleep quality for patients with PsA of 72.9% (95% CI 63-81.8; I2 = 78%), which was statistically higher than in healthy controls (26.9%, 95% CI 11.7-45.4; I2 = 81%) but not significantly different than in patients with psoriasis (59.8%, 95% CI 46.9-72.1; I2 = 51%). Sleep disturbance was ranked in the top 4 health-related quality of life domains affected by PsA. One study suggested a bidirectional relationship between PsA and obstructive sleep apnea. Predictors of sleep problems included anxiety, pain, erythrocyte sedimentation rate, depression, fatigue, physical function, and tender or swollen joint count. Tumor necrosis factor inhibitors, guselkumab, and filgotinib (a Janus kinase inhibitor) were associated with improved sleep outcomes. CONCLUSION Poor sleep quality is prevalent in patients with PsA. Objective sleep measures (ie, actigraphy and polysomnography) have not been used in PsA studies, and evidence on the validity of patient-reported sleep measures in PsA is lacking. Future studies should validate self-reported sleep measures in PsA, explore how sleep quality relates to PsA disease activity and symptoms using both objective and subjective sleep measures, assess the efficacy of strategies to manage sleep problems, and assess the effects of such management on symptoms and disease signs in patients with PsA.
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Affiliation(s)
- Carly Grant
- C. Grant, BS, Department of Dermatology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael Woodbury
- M. Woodbury, BS, Department of Dermatology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Marie Skougaard
- M. Skougaard, MD, Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens K Boldsen
- J.K. Boldsen, MSc, PhD, Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Alexis Ogdie
- A. Ogdie, MD, MSCE, Department of Medicine/Division of Rheumatology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elizabeth B Klerman
- E.B. Klerman, MD, PhD, Department of Neurology, Massachusetts General Hospital, Boston, and Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph F Merola
- J.F. Merola, MD, MMSc, Department of Dermatology and Medicine, Division of Rheumatology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Lourdes M Perez-Chada
- L.M. Perez-Chada, MD, MMSc, Department of Dermatology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
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5
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Spencer RK, Elhage KG, Jin JQ, Davis MS, Hakimi M, Bhutani T, Chang H, Liao W. Living with Psoriasis Vulgaris and Multi-Treatment Failure: A Patient and Dermatologist Perspective. Dermatol Ther (Heidelb) 2023; 13:857-866. [PMID: 36913122 DOI: 10.1007/s13555-023-00907-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/15/2023] [Indexed: 03/14/2023] Open
Abstract
Psoriasis vulgaris is a systemic, chronic inflammatory disease affecting 2-3% of the population. Recent advances in the understanding of the pathophysiology of psoriatic disease have facilitated the development of novel therapeutic options with improved safety and efficacy. This article is coauthored by a patient with a lifelong history of psoriasis who experienced multiple treatment failures. He details his diagnosis and treatment experiences, as well as the physical, mental, and social ramifications of his skin condition. He then goes on to elaborate how evolutions in the treatment of psoriatic disease have impacted his life. This case is then discussed from the perspective of a dermatologist specializing in inflammatory skin disorders. We highlight the clinical features of psoriasis, its medical and psychosocial comorbidities, and the current landscape of psoriatic disease treatments.
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Affiliation(s)
- Riley K Spencer
- Department of Dermatology, University of California San Francisco, Floor 04, Room N426, 2340 Sutter Street, Box 0808, San Francisco, CA, 94115, USA.,Midwestern University, Arizona College of Osteopathic Medicine, Glendale, AZ, USA
| | - Kareem G Elhage
- Department of Dermatology, University of California San Francisco, Floor 04, Room N426, 2340 Sutter Street, Box 0808, San Francisco, CA, 94115, USA
| | - Joy Q Jin
- Department of Dermatology, University of California San Francisco, Floor 04, Room N426, 2340 Sutter Street, Box 0808, San Francisco, CA, 94115, USA.,School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Mitchell S Davis
- Department of Dermatology, University of California San Francisco, Floor 04, Room N426, 2340 Sutter Street, Box 0808, San Francisco, CA, 94115, USA
| | - Marwa Hakimi
- Department of Dermatology, University of California San Francisco, Floor 04, Room N426, 2340 Sutter Street, Box 0808, San Francisco, CA, 94115, USA
| | - Tina Bhutani
- Department of Dermatology, University of California San Francisco, Floor 04, Room N426, 2340 Sutter Street, Box 0808, San Francisco, CA, 94115, USA
| | | | - Wilson Liao
- Department of Dermatology, University of California San Francisco, Floor 04, Room N426, 2340 Sutter Street, Box 0808, San Francisco, CA, 94115, USA.
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6
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VLAMI K, PANTELIDI K, DALAMAGA M, KARAGIANNI F, THEODOROPOULOS K, PAPIRIS S, PAPADAVID E. Psoriatic Insomnia: A Subjective and Objective Sleep Evaluation. Acta Derm Venereol 2023; 103:adv00864. [PMID: 36786739 PMCID: PMC9940723 DOI: 10.2340/actadv.v103.4507] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/16/2022] [Indexed: 02/15/2023] Open
Abstract
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.
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Affiliation(s)
| | - Kleoniki PANTELIDI
- Second Department of Dermatology, Medical School, National and Kapodistrian University of Athens, Attikon General University Hospital
| | - Maria DALAMAGA
- Second Department of Dermatology, Medical School, National and Kapodistrian University of Athens, Attikon General University Hospital,Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Fani KARAGIANNI
- Second Department of Dermatology, Medical School, National and Kapodistrian University of Athens, Attikon General University Hospital
| | - Konstantinos THEODOROPOULOS
- Second Department of Dermatology, Medical School, National and Kapodistrian University of Athens, Attikon General University Hospital
| | | | - Evangelia PAPADAVID
- Second Department of Dermatology, Medical School, National and Kapodistrian University of Athens, Attikon General University Hospital
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7
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Stenger S, Grasshoff H, Hundt JE, Lange T. Potential effects of shift work on skin autoimmune diseases. Front Immunol 2023; 13:1000951. [PMID: 36865523 PMCID: PMC9972893 DOI: 10.3389/fimmu.2022.1000951] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/29/2022] [Indexed: 02/16/2023] Open
Abstract
Shift work is associated with systemic chronic inflammation, impaired host and tumor defense and dysregulated immune responses to harmless antigens such as allergens or auto-antigens. Thus, shift workers are at higher risk to develop a systemic autoimmune disease and circadian disruption with sleep impairment seem to be the key underlying mechanisms. Presumably, disturbances of the sleep-wake cycle also drive skin-specific autoimmune diseases, but epidemiological and experimental evidence so far is scarce. This review summarizes the effects of shift work, circadian misalignment, poor sleep, and the effect of potential hormonal mediators such as stress mediators or melatonin on skin barrier functions and on innate and adaptive skin immunity. Human studies as well as animal models were considered. We will also address advantages and potential pitfalls in animal models of shift work, and possible confounders that could drive skin autoimmune diseases in shift workers such as adverse lifestyle habits and psychosocial influences. Finally, we will outline feasible countermeasures that may reduce the risk of systemic and skin autoimmunity in shift workers, as well as treatment options and highlight outstanding questions that should be addressed in future studies.
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Affiliation(s)
- Sarah Stenger
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Hanna Grasshoff
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Jennifer Elisabeth Hundt
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
- Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Tanja Lange
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
- Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
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8
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Afvari S, Beck TC, Kazlouskaya M, Afrahim R, Valdebran M. Diet, sleep, and exercise in inflammatory skin diseases. OUR DERMATOLOGY ONLINE 2023; 14:430-435. [PMID: 38161767 PMCID: PMC10755759 DOI: 10.7241/ourd.20234.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Inflammatory skin conditions are significantly impacted by lifestyle habits, particularly those related to diet, exercise, and sleep. Although ancient cultures emphasized the importance of lifestyle behaviors as both etiology and therapy in disease, modern medicine often overlooks nonpharmacological therapy. However, recent studies show that diet can have a significant impact on inflammatory skin diseases such as psoriasis, hidradenitis suppurativa, and atopic dermatitis. Foods high in glycemic index, advanced glycation end-products, and omega-6 polyunsaturated fatty acids are associated with obesity and systemic inflammation, which can exacerbate inflammatory skin diseases. In addition, lifestyle behaviors such as exercise and sleep have been shown to have positive effects on inflammatory skin diseases. This review aims to highlight the importance of lifestyle behaviors in the context of inflammation and inflammatory dermatoses.
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Affiliation(s)
- Shawn Afvari
- New York Medical College School of Medicine, Valhalla, New York, USA
| | - Tyler C. Beck
- Medical University of South Carolina, Medical Scientist Training Program, Charleston, South Carolina, USA
| | | | - Ryan Afrahim
- University of California Los Angeles, Los Angeles, California, USA
| | - Manuel Valdebran
- Department of Dermatology, Medical University of South Carolina, Charleston, South Carolina, USA
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9
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Halioua B, Chelli C, Misery L, Taieb J, Taieb C. Sleep Disorders and Psoriasis: An Update. Acta Derm Venereol 2022; 102:adv00699. [PMID: 35191513 PMCID: PMC9574693 DOI: 10.2340/actadv.v102.1991] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Psoriasis alters patients’ quality of life. Among the disorders associated with psoriasis, sleep disorders are common, although they are not directly assessed by most quality-of-life scores. Thus, the specific evaluation of sleep disorders using dedicated scores is necessary, especially because such disorders alter patients;’ physical and psychological health. The relationship between psoriasis and sleep disorders has been shown in numerous studies, but has not yet been fully elucidated. The aim of this study was to update knowledge of sleep disorders in patients with psoriasis, through a review of the scientific literature since 1980. This work covers several topics of interest, such as sleep assessment methods, the prevalence of sleep disorders in patients with psoriasis, factors predictive of sleep disorders in patients with psoriasis, the impact of sleep disorders on comorbidities and quality of life, pathogenic mechanisms, obstructive sleep apnoea and restless leg syndromes, and the impact of biotherapy treatments on sleep disorders in patients with psoriasis.
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10
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Skougaard M, Stisen ZR, Jørgensen TS, Egeberg A, Hansen RL, Perez-Chada LM, Mogensen M, Merola JF, Gerwien JG, Kristensen LE. Increased prevalence of sleep disturbance in psoriatic arthritis is associated with inflammatory and non-inflammatory measures. Scand J Rheumatol 2022; 52:259-267. [PMID: 35302402 DOI: 10.1080/03009742.2022.2044116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To examine the prevalence of sleep disturbances, quantified by the Pittsburgh Sleep Quality Index (PSQI), in patients with psoriatic arthritis (PsA), psoriasis (PsO) and healthy controls (HCs), explore associations between PSQI and clinical and patient-reported outcomes, and evaluate the effect of treatment on PSQI. METHOD Patients were included from the Parker Institute's PsA patient cohort to evaluate the prevalence of sleep disturbances. Univariate and multivariate regression analyses were used to explore associations between sleep disturbance and outcome measures. Treatment effect in PsA patients was assessed with a mixed-effect model for repeated measures. RESULTS In total, 109 PsA patients, 20 PsO patients, and 20 HCs were included. Sleep disturbances were reported by 66.1% of PsA patients, 45.0% of PsO patients, and 15.0% of HCs. Univariate regression analyses revealed statistically significant associations (p < 0.001) between PSQI and Disease Activity Score (DAS28CRP), tender points, visual analogue scale (VAS) patient global and pain, Psoriatic Arthritis Impact of Disease fatigue, Health Assessment Questionnaire (HAQ), and painDETECT score. Multivariate regression analysis demonstrated VAS patient global, VAS pain, and tender points as being independently associated with PSQI. The mixed-effect model revealed no effect of treatment. CONCLUSION More PsA patients than PsO patients and HCs reported sleep disturbances. Sleep disturbances were associated with inflammatory and non-inflammatory measures possibly explaining the limited effect of treatment. This demonstrates the need for interdisciplinary approaches to improve the management of sleep disturbance in PsA.Trial registration: ClinicalTrials.gov (NCT02572700).
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Affiliation(s)
- M Skougaard
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Z R Stisen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - T S Jørgensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - A Egeberg
- Department of Dermatology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - R L Hansen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - L M Perez-Chada
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - M Mogensen
- Department of Dermatology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - J F Merola
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Dermatology and Department of Medicine, Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - L E Kristensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
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11
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Nocturnal pruritus and sleep disturbance associated with dermatologic disorders in adult patients. Int J Womens Dermatol 2021; 7:403-410. [PMID: 34632036 PMCID: PMC8484989 DOI: 10.1016/j.ijwd.2021.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/26/2021] [Accepted: 02/26/2021] [Indexed: 11/22/2022] Open
Abstract
Nocturnal pruritus (NP) is a relatively common reason for dermatologic consultation. Its pathophysiology is partially understood. Skin conditions such as atopic dermatitis, psoriasis, urticaria, and prurigo nodularis are well-described causes of NP. The most distressing sequela of NP is sleep deficit, which can lead to physical and mental disturbances (e.g., daytime somnolence and fatigue) and negative emotional states that profoundly affect quality of life. However, this aspect of NP is often overlooked by dermatologists. It is essential to assess sleep quality in such patients and adopt appropriate measures to arrest the problem at an early stage. We conducted an evidence-based literature review to highlight the pathogenetic mechanisms of NP, identify dermatologic etiologies, and explore methods that have been used to assess the quality of sleep. Furthermore, we performed a systematic review of studies on sleep disturbance relevant to NP in patients with dermatologic conditions. Finally, we discuss the evidence on treatment options for NP and indicate therapies that may target both NP and sleep disturbance.
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12
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Enhancing patient research partner engagement: Research in psoriatic arthritis. Best Pract Res Clin Rheumatol 2021; 35:101685. [DOI: 10.1016/j.berh.2021.101685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Myers B, Vidhatha R, Nicholas B, Stephanie C, Quinn T, Chang HW, Bhutani T, Liao W. Sleep and the gut microbiome in psoriasis: clinical implications for disease progression and the development of cardiometabolic comorbidities. JOURNAL OF PSORIASIS AND PSORIATIC ARTHRITIS 2021; 6:27-37. [PMID: 35784674 PMCID: PMC9249097 DOI: 10.1177/2475530320964781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Background Sleep dysfunction and sleep disorders are important comorbidities of psoriasis. Not only do these sleep comorbidities contribute to reduced quality of life, but they may also lead to worsening psoriasis and increased susceptibility to cardiometabolic diseases. While psoriasis and sleep dysfunction are thought to be linked by itch, depression, and immune system dysregulation, the relationship between psoriasis and sleep dysfunction is not yet fully understood. Objective We sought to compare previous studies characterizing the gut microbiome in psoriasis and sleep dysfunction and examine the potential relevance of shared findings on cardiometabolic and overall health. Methods We performed literature searches of PubMed and Embase databases to find studies evaluating the gut microbiome in psoriasis, sleep dysfunction, and cardiometabolic diseases. Results Studies characterizing the gut microbiome in psoriasis and sleep dysfunction reveal shared findings, specifically an increased Firmicutes to Bacteroidetes ratio and reduced abundance of short chain fatty acid-producing bacteria. These dysbiotic features have also been shown to promote systemic inflammation and cardiometabolic disease. Conclusion In favoring an increased Firmicutes to Bacteroidetes ratio and reduced abundance of short chain fatty acid-producing bacteria, sleep dysfunction could be contributing to worsening psoriasis and cardiometabolic comorbidities through intestinal dysbiosis. Future studies are needed to determine whether gut- and sleep-targeting interventions could be therapeutic in psoriasis patients with poor sleep.
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Affiliation(s)
- Bridget Myers
- University of California, San Francisco, Department of Dermatology
| | - Reddy Vidhatha
- University of California, San Francisco, Department of Dermatology
| | | | - Chan Stephanie
- University of California, San Francisco, Department of Dermatology
| | - Thibodeaux Quinn
- University of California, San Francisco, Department of Dermatology
| | - Hsin-Wen Chang
- University of California, San Francisco, Department of Dermatology
| | - Tina Bhutani
- University of California, San Francisco, Department of Dermatology
| | - Wilson Liao
- University of California, San Francisco, Department of Dermatology
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Palominos PE, Coates L, Kohem CL, Orbai AM, Smolen J, de Wit M, Kiltz U, Leung YY, Cañete JD, Scrivo R, Balanescu A, Dernis E, Meisalu S, Soubrier M, Aydin SZ, Gaydukova I, Kalyoncu U, Gossec L. Determinants of sleep impairment in psoriatic arthritis: An observational study with 396 patients from 14 countries. Joint Bone Spine 2020; 87:449-454. [DOI: 10.1016/j.jbspin.2020.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/31/2020] [Indexed: 01/07/2023]
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Myers B, Reddy V, Chan S, Thibodeaux Q, Brownstone N, Bhutani T. Sleep, Immunological Memory, and Inflammatory Skin Disease. Dermatology 2020; 237:1035-1038. [DOI: 10.1159/000510082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/09/2020] [Indexed: 11/19/2022] Open
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Patel SP, Khanna R, Choi J, Williams KA, Roh YS, Hong MS, Sutaria NH, Pritchard T, Kwatra MM, Kwatra SG. Sleep disturbance in adults with chronic pruritic dermatoses is associated with increased C-reactive protein levels. J Am Acad Dermatol 2020; 84:265-272. [PMID: 32822785 DOI: 10.1016/j.jaad.2020.08.059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/13/2020] [Accepted: 08/07/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Pruritus is a common symptom that can significantly reduce quality of life through sleep disruption. OBJECTIVE To examine features of disturbed sleep in patients with chronic pruritic dermatoses and test the hypothesis that systemic inflammation may serve as a biomarker for impaired sleep in these patients. METHODS Cross-sectional analysis of the National Health and Nutrition Examination Survey investigating systemic inflammation using C-reactive protein (CRP) levels. Logistic regression was used to compare patients with and without sleep disturbances, adjusting for demographics (model 1) and medical comorbidities (model 2). RESULTS Chronic pruritic dermatoses were associated with multiple sleep disturbances, including nighttime awakenings (model 1: odds ratio [OR], 1.646; 95% confidence interval [CI], 1.031-2.627; model 2: OR, 1.329; 95% CI, 0.888-1.989) and early morning awakening (model 1: OR, 1.669, 95% CI, 1.118-2.493; model 2: OR, 1.582; 95% CI, 1.008-2.481). Mean CRP levels were 52.8% higher among patients with pruritic dermatoses reporting trouble sleeping compared with those who did not (0.663 vs 0.434 mg/dL; P = .034). Trouble sleeping was also positively correlated with CRP levels (β = 0.142, P = .025). LIMITATIONS Potential recall bias among participants. CONCLUSIONS In addition to confirming sleep disturbances with pruritic dermatoses, we found these disturbances are more likely to present with elevated CRP levels. Clinicians should consider the potential risk for sleep-related and cardiac comorbidities in patients diagnosed with itchy skin conditions.
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Affiliation(s)
- Sagar P Patel
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Raveena Khanna
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Creighton University School of Medicine, Omaha, Nebraska
| | - Justin Choi
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kyle A Williams
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Youkyung S Roh
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael S Hong
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nishadh H Sutaria
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Thomas Pritchard
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Madan M Kwatra
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Reddy V, Myers B, Brownstone N, Thibodeaux Q, Chan S, Liao W, Bhutani T. Update on Sleep and Pulmonary Comorbidities in Psoriasis. CURRENT DERMATOLOGY REPORTS 2020. [DOI: 10.1007/s13671-020-00293-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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18
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Damiani G, Bragazzi N, Garbarino S, Chattu VK, Shapiro CM, Pacifico A, Malagoli P, Pigatto PDM, Conic RR, Tiodorovic D, Watad A, Adawi M. Psoriatic and psoriatic arthritis patients with and without jet-lag: does it matter for disease severity scores? Insights and implications from a pilot, prospective study. Chronobiol Int 2019; 36:1733-1740. [PMID: 31645138 PMCID: PMC6832868 DOI: 10.1080/07420528.2019.1678629] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 10/04/2019] [Indexed: 12/13/2022]
Abstract
Background: Jet-lag may affect air-travelers crossing at least two time-zones and has several health-care implications. It occurs when the human biological rhythms are out of synch with respect to the day-night cycle at the country destination. Its effect in psoriasis is missing. We aimed to evaluate the effect of Jet-lag in psoriatic patients' management. Methods: This is a prospective observational study that enrolled psoriatic patients that underwent a flight: patients who experienced jet-lag were compared to patients who did not experience jet-lag. Before the flight, a dermatologist recorded clinical and demographical data with particular attention to Psoriasis Area Severity Index (PASI) and Disease Activity in Psoriatic Arthritis (DAPSA). Patients performed Self-Administered Psoriasis Area Severity Index (SAPASI), the Dermatology Life Quality Index (DLQI) and the pruritus Visual Analog Scale (VAS) scores. After the flight, patients completed the SAPASI, DLQI and pruritus-VAS scores. Results: The sample recruited comprised of 70 psoriatic patients aged 42.4 ± 9.7 years (median 42.5 years). Thirty (42.9%) were males, mean BMI was 25.5 ± 2.2 kg/m2. Average disease duration was 15.2 ± 7.1 years, and 20 (28.6%) subjects had developed PsA. Average hours of flight were 5.4 ± 3.5 (median 3.5 h), with 34 (48.6%) subjects reporting jet-lag. At the multivariate regression analysis, the change in the SAPASI score resulted correlated with jet-lag (regression coefficient 1.63, p = .0092), as well the change in the DLQI score (regression coefficient = 1.73, p = .0009), but no change on the pruritus VAS scale was found. Conclusions: The present study suggests that jet-lag may influence disease severity and DLQI scores, but not itch in psoriatic patients.
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Affiliation(s)
- G. Damiani
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Department of Dermatology, Case Western Reserve University, Cleveland, OH, USA
- Young Dermatologists Italian Network, Centro Studi GISED, Bergamo, Italy
| | - N.L. Bragazzi
- Young Dermatologists Italian Network, Centro Studi GISED, Bergamo, Italy
- Postgraduate School of Public Health, Department of Health Sciences, University of Genoa, Genoa, Italy
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences (DINOGMI), University of Genoa, Genoa, Italy
| | - S. Garbarino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences (DINOGMI), University of Genoa, Genoa, Italy
| | - V. K. Chattu
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Youthdale Child and Adolescent Sleep Centre, Toronto, Ontario, Canada
| | - C. M. Shapiro
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Youthdale Child and Adolescent Sleep Centre, Toronto, Ontario, Canada
| | - A. Pacifico
- San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - P. Malagoli
- Dermatology Unit, Azienda Ospedaliera San Donato Milanese, Milan, Italy
| | - P. D. M. Pigatto
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - R. R.Z. Conic
- Department of Surgery, University of Maryland, Baltimore, MD, USA
| | - D. Tiodorovic
- Dermatology Clinic, Medical Faculty, Nis University, Nis, Serbia
| | - A. Watad
- Department of Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M. Adawi
- Padeh and Ziv Hospitals, Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
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