Sleep Disturbance, Anxiety and Depression Observed in Adult Psoriasis Patients

Ergun Sahin, MD, PhD

A new investigation into psoriasis found that sleep disturbance in adult patients was highly prevalent.

Investigators believe that the data showed reductions in pruritus should be considered an important therapeutic goal, along with therapies intended to reduce anxiety and depression.

Previous research has made associations between sleep and psoriasis. However, the role of different potential sleep confounding factors such as pruritis characteristics and several psychological variables including anxiety and depression have remained insufficiently investigated.

As such investigators led by Ergun Sahin, MD, PhD, Department of Dermatology at University Medicine Berlin, investigated sleep characteristics and identified clinical, demographic, and psychological factors associated with sleep disturbance in psoriasis patients.

The Methods

The cross-sectional, questionnaire-based study was part of a larger international project for investigation of characteristics of pruritis and disease burden in patients with psoriasis called Characterization of Disease Burden and Itch in Psoriasis (ChIP) that was conducted in Germany, Poland, Russia, and Turkey.

Sahin and colleagues presented data from the German patients and control subjects.

From December 2015 to February 2017, the study enrolled adult German speaking patients with psoriasis from in- and out-patient clinics and the day care unit of the dermatology department in Charité University Medicine. Each patient with a dermatologist-diagnosed case of psoriasis with lesions and without active psoriasis arthropathic were included.

Clinical characteristics were recorded based on clinical interviews and medical records, and the severity of comorbidities was assessed via the Cumulative Illness Rating Scale (CIRS). Psoriasis severity was assessed using Psoriasis Area and Severity Index (PASI) and body surface area (BSA).

From there, pruritis intensity during the last week of the study was assessef using the 5-piont Likert scale, and the team used the PSQI to assess sleep disturbance and sleep quality across 4 weeks.

The PSQI consisted of 19 items grouped into 7 components includingsubjective sleepquality,sleep latency, sleepduration, habitualsleepefficiency, sleepdisturbances, useofsleepingmedication, and daytime dysfunction. Each item was scored from 0-3.

Finally, the Hospital Anxiety and Depression Scale (HADS) assessed anxiety and depression, and the 12-item Short Form Survey (SF-12) was used to assess generic health-related quality of life (HR-QoL).

The Findings

A total of 286 patients with psoriasis and 125 control subjects were included in the study.

Among them, 59% of patients and 34% of control subjects (P<0.001) suffered from sleep disturbance (PSQI>5). Patients with psoriasis slept 1 hour less than control subjects (median 6 vs. 7 hours, P<0.001) and had very strong pruritis (P<0.001).

Investigators noted that anxiety and depression were the strongest predictors of sleep impairment, followed by pruritis exacerbation at night, age, female sex, pruritis exacerbation in the morning, average pruritis intensity (VAS), diagnosed depression and gastroesophageal reflux disease.

Altogether, this explained 32%-37% of the variance in global sleep quality, and both anxiety and depression were mediators that explained the association between pruritis intensity and sleep impairment in 42% and 37%, respectively.

“Our results indicatethatespeciallyinpatientswithstrongandvery strongpruritusorpruritusexacerbatingatnightorinthemorning,itsreductionshouldbe considered as an important therapeutic goal,” the team wrote. “Providing complementary psychotherapy aimed at reducing anxiety,depressionandpsychologicaldistressmayhelpto improve sleep in patients with psoriasis.”

The study, "Prevalence and factors associated with sleep disturbance in adult patients with psoriasis," was published online in the Journal of The European Academy of Dermatology and Venereology.