Sleep in psoriasis: A meta-analysis

Miaolan Guo; Jing Su; Shaoyan Zheng; Baixin Chen

doi:10.1016/j.jpsychores.2023.111543

Sleep in psoriasis: A meta-analysis

J Psychosom Res. 2024 Jan:176:111543. doi: 10.1016/j.jpsychores.2023.111543. Epub 2023 Nov 8.

Authors

Miaolan Guo¹, Jing Su¹, Shaoyan Zheng², Baixin Chen³

Affiliations

¹ Department of Nursing, Shantou University Medical College, Shantou 515000, China.
² Academic Affairs Office, Shantou University Medical College, Shantou 515000, China.
³ Department of Sleep Medicine, Shantou University Mental Health Center, Shantou University Medical College, Shantou 515000, China; Sleep Medicine Center, Shantou University Medical College, Shantou 515000, China; Shantou University Medical College-Faculty of Medicine of University of Manitoba Joint Laboratory of Biological Psychiatry, Shantou 515000, China. Electronic address: 15bxchen@stu.edu.cn.

PMID: 37956475
DOI: 10.1016/j.jpsychores.2023.111543

Abstract

Objective: Currently, there are discrepant results regarding the quantitative effect of psoriasis on sleep, which may, in part, be attributed to the use of non-standardised questionnaires.

Methods: The PubMed/Medline, Embase, and Cochrane databases were searched for cross-sectional, case-control or cohort studies that recruited patients with psoriasis and healthy controls and reported data regarding Pittsburgh Sleep Quality Index (PSQI) and the prevalence of sleep disturbance (SD) based on the PSQI, published from inception up to January 2023. Secondary outcomes included scores for the Insomnia Severity Index (ISI), Beck Depression Inventory (BDI), and Epworth Sleepiness Scale (ESS), and risk for restless legs syndrome (RLS). Meta-analyses using random-effects models were used for statistical analyses.

Results: Fifteen studies including 1274 patients with psoriasis and 775 controls were analysed. A higher PSQI (weighted mean difference [WMD] = 3.397, P < 0.001, I² = 84.2%) and a higher risk for SD (odds ratio [OR] = 6.640, P < 0.001, I² = 67.5%) were observed in patients with psoriasis compared with controls. Subgroup analyses revealed a greater difference in PSQI score and/or risk for SD between patients with psoriasis and controls in subgroups of psoriatic arthritis, moderate-to-severe psoriasis, shorter psoriasis duration, and younger age. Moreover, patients with psoriasis exhibited higher ISI (WMD = 2.709, P < 0.001) and BDI scores (WMD = 4.565, P = 0.001), and risk for RLS (OR = 4.689, P = 0.01). However, there was no significant difference in ESS scores (WMD = -0.229, P = 0.77) compared with controls.

Conclusion: Psoriasis was associated with poor sleep quality and higher risk for SD, especially among patients with psoriatic arthritis, severe psoriasis, shorter duration of psoriasis, and younger age. Patients with psoriasis were also more likely to experience insomnia, RLS, and depression.

Keywords: Insomnia; Psoriasis; Psoriatic arthritis; Restless legs syndrome; Sleep.

Publication types

Meta-Analysis

MeSH terms

Arthritis, Psoriatic* / complications
Cross-Sectional Studies
Humans
Psoriasis* / complications
Restless Legs Syndrome* / epidemiology
Severity of Illness Index
Sleep
Sleep Initiation and Maintenance Disorders* / complications
Sleep Wake Disorders* / complications
Sleep Wake Disorders* / etiology