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Psoriasis is associated with risk of obstructive sleep apnea independently from metabolic parameters and other comorbidities: a large hospital-based case-control study

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Obstructive sleep apnea (OSA) represents a breathing disorder during sleep with significant health consequences. Few studies have examined the prevalence of OSA in psoriatic patients and whether OSA may be associated with psoriasis risk. We aimed to explore: (1) the inverse relationship, that is whether psoriasis might represent an independent predictor of OSA and its severity considering important predisposing factors and (2) the psoriatic phenotype related to severe OSA.

Methods

In a large hospital-based case-control study, we examined a total of 253 patients with OSA and a control group of 104 subjects without OSA, who underwent full nocturnal polysomnography and dermatologic examination.

Results

The prevalence of psoriasis was significantly greater in OSA patients than in controls (p = 0.03). Psoriasis was associated with OSA risk (p = 0.04) but not severity of OSA, sleepiness severity or sleep efficiency, independently from age, gender, anthropometric features, and significant comorbidities. The phenotype of a psoriatic patient suffering from severe OSA is not different from that of a patient with severe OSA and is not associated with psoriasis severity indexes. OSA psoriatic patients were not compliant with CPAP treatment in comparison with OSA patients without psoriasis.

Conclusion

Psoriasis may represent an independent risk factor for OSA above and beyond significant comorbidities, anthropometric and metabolic parameters. Physicians should be aware of the bi-directional association of psoriasis and OSA. Managing psoriasis may be a potential target for preventing OSA as well as the potential cardiovascular mortality related to OSA and psoriasis.

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Abbreviations

AHI:

Apnea-hypopnea index

BMI:

Body mass index

CVD:

Cardiovascular disease

CPAP:

Continuous positive airway pressure

CRP:

C-reactive protein

DLQI:

Dermatology life quality index

ECG:

Electrocardiogram

EEG:

Electroencephalogram

ESS:

Epworth sleepiness scale

HIF-1α:

Hypoxia-inducible factor 1-alpha

HPA:

Hypothalamic-pituitary-adrenal

IGF:

Insulin growth factor

IL:

Interleukin

IR:

Insulin resistance

NC:

Neck circumference

NF-κB:

Nuclear factor kappa-light-chain-enhancer of activated B cells

NPSG:

Nocturnal polysomnography

OSA:

Obstructive sleep apnea

PASI:

Psoriasis area and severity index

ROS:

Reactive oxygen species

SD:

Standard deviation

t2DM:

Type 2 diabetes mellitus

TNF-α:

Tumor necrosis factor-α

UAW:

Upper airway

VEGF:

Vascular endothelial growth factor

WC:

Waist circumference

References

  1. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235. doi:10.1056/nejm199304293281704

    Article  CAS  PubMed  Google Scholar 

  2. Park JG, Ramar K, Olson EJ (2011) Updates on definition, consequences, and management of obstructive sleep apnea. Mayo Clin Proc 86:549–555. doi:10.4065/mcp.2010.0810

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bagai K (2010) Obstructive sleep apnea, stroke, and cardiovascular diseases. Neurologist 16:329–339. doi:10.1097/NRL.0b013e3181f097cb

    Article  PubMed  Google Scholar 

  4. Yang YW, Kang JH, Lin HC (2012) Increased risk of psoriasis following obstructive sleep apnea: a longitudinal population-based study. Sleep Med 13:285–289. doi:10.1016/j.sleep.2011.07.018

    Article  PubMed  Google Scholar 

  5. Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N, Mooser V, Preisig M, Malhotra A, Waeber G, Vollenweider P, Tafti M, Haba-Rubio J (2015) Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med 3:310–318. doi:10.1016/s2213-2600(15)00043-0

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Tufik S, Santos-Silva R, Taddei JA, Bittencourt LR (2010) Obstructive sleep apnea syndrome in the Sao Paulo epidemiologic sleep study. Sleep Med 11:441–446. doi:10.1016/j.sleep.2009.10.005

    Article  PubMed  Google Scholar 

  7. Reich K (2012) The concept of psoriasis as a systemic inflammation: implications for disease management. J Eur Acad Dermatol Venereol 26(Suppl 2):3–11. doi:10.1111/j.1468-3083.2011.04410.x

    Article  PubMed  Google Scholar 

  8. Nestle FO, Kaplan DH, Barker J (2009) Psoriasis. N Engl J Med 361:496–509. doi:10.1056/NEJMra0804595

    Article  CAS  PubMed  Google Scholar 

  9. Dalamaga M, Papadavid E (2013) Adipocytokines and psoriasis: insights into mechanisms linking obesity and inflammation to psoriasis. World J Dermatol 2:27–31

    Article  Google Scholar 

  10. Dalamaga M, Papadavid E (2013) Metabolic comorbidities and psoriasis: the chicken or the egg? World J Dermatol 2:32–35

    Article  Google Scholar 

  11. Armstrong AW, Harskamp CT, Armstrong EJ (2013) Psoriasis and metabolic syndrome: a systematic review and meta-analysis of observational studies. J Am Acad Dermatol 68:654–662. doi:10.1016/j.jaad.2012.08.015

    Article  PubMed  Google Scholar 

  12. Hirotsu C, Nogueira H, Albuquerque RG, Tomimori J, Tufik S, Andersen ML (2015) The bidirectional interactions between psoriasis and obstructive sleep apnea. Int J Dermatol 54:1352–1358. doi:10.1111/ijd.13026

    Article  PubMed  Google Scholar 

  13. Papadavid E, Vlami K, Dalamaga M, Giatrakou S, Theodoropoulos K, Gyftopoulos S, Stavrianeas N, Papiris S, Rigopoulos D (2013) Sleep apnea as a comorbidity in obese psoriasis patients: a cross-sectional study. Do psoriasis characteristics and metabolic parameters play a role? J Eur Acad Dermatol Venereol 27:820–826. doi:10.1111/j.1468-3083.2012.04580.x

    Article  CAS  PubMed  Google Scholar 

  14. Karaca S, Fidan F, Erkan F, Nural S, Pinarci T, Gunay E, Unlu M (2013) Might psoriasis be a risk factor for obstructive sleep apnea syndrome? Sleep Breath 17:275–280. doi:10.1007/s11325-012-0686-2

    Article  PubMed  Google Scholar 

  15. Dalamaga M, Papadavid E, Vlami K (2013) Unmasking the Janus face of the association between psoriasis, metabolic syndrome and obstructive sleep apnea. Sleep Breath 17:449–450. doi:10.1007/s11325-012-0749-4

    Article  PubMed  Google Scholar 

  16. Cohen JM, Jackson CL, Li TY, Wu S, Qureshi AA (2015) Sleep disordered breathing and the risk of psoriasis among US women. Arch Dermatol Res 307:433–438. doi:10.1007/s00403-015-1536-4

    Article  PubMed  Google Scholar 

  17. Shalom G, Dreiher J, Cohen A (2016) Psoriasis and obstructive sleep apnea. Int J Dermatol 55:e579–e584. doi:10.1111/ijd.13367

    Article  PubMed  Google Scholar 

  18. Egeberg A, Khalid U, Gislason GH, Mallbris L, Skov L, Hansen PR (2016) Psoriasis and sleep apnea: a Danish nationwide cohort study. J Clin Sleep Med 12:663–671. doi:10.5664/jcsm.5790

    Article  PubMed  PubMed Central  Google Scholar 

  19. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545

    Article  CAS  PubMed  Google Scholar 

  20. Iber C, Ancoli-Israel S, Stuart Quan M (2007) The American Academy of Sleep Medicine Manual for the scoring of sleep and associated events: rules, terminology, and technical specifications. American Academy of Sleep Medicine, Westchester, Illinois

    Google Scholar 

  21. Bassukas ID, Mavridou KA, Evangelou T, Gaitanis G (2011) The prevalence of psoriasis among elderly individuals: more questions than answers. Ageing Res 3(e1):1–2. doi:10.4081/ar.2011.e1

    Article  Google Scholar 

  22. Boehncke WH, Schon MP (2015) Psoriasis. Lancet 386:983–994. doi:10.1016/s0140-6736(14)61909-7

    Article  CAS  PubMed  Google Scholar 

  23. Kim N, Thrash B, Menter A (2010) Comorbidities in psoriasis patients. Semin Cutan Med Surg 29:10–15. doi:10.1016/j.sder.2010.01.002

    Article  CAS  PubMed  Google Scholar 

  24. Lee MS, Lin RY, Lai MS (2014) Increased risk of diabetes mellitus in relation to the severity of psoriasis, concomitant medication, and comorbidity: a nationwide population-based cohort study. J Am Acad Dermatol 70:691–698. doi:10.1016/j.jaad.2013.11.023

    Article  PubMed  Google Scholar 

  25. van der Voort EA, Koehler EM, Dowlatshahi EA, Hofman A, Stricker BH, Janssen HL, Schouten JN, Nijsten T (2014) Psoriasis is independently associated with nonalcoholic fatty liver disease in patients 55 years old or older: results from a population-based study. J Am Acad Dermatol 70:517–524. doi:10.1016/j.jaad.2013.10.044

    Article  PubMed  Google Scholar 

  26. Yang YW, Keller JJ, Lin HC (2011) Medical comorbidity associated with psoriasis in adults: a population-based study. Br J Dermatol 165:1037–1043. doi:10.1111/j.1365-2133.2011.10494.x

    Article  PubMed  Google Scholar 

  27. Hjuler KF, Bottcher M, Vestergaard C, Botker HE, Iversen L, Kragballe K (2016) Association between changes in coronary artery disease progression and treatment with biologic agents for severe psoriasis. JAMA Dermatol 152:1114–1121. doi:10.1001/jamadermatol.2016.1984

    Article  PubMed  Google Scholar 

  28. Maari C, Bolduc C, Nigen S, Marchessault P, Bissonnette R (2014) Effect of adalimumab on sleep parameters in patients with psoriasis and obstructive sleep apnea: a randomized controlled trial. J Dermatolog Treat 25:57–60. doi:10.3109/09546634.2012.713458

    Article  CAS  PubMed  Google Scholar 

  29. Buslau M, Benotmane K (1999) Cardiovascular complications of psoriasis: does obstructive sleep apnoea play a role? Acta Derm Venereol 79:234

    Article  CAS  PubMed  Google Scholar 

  30. Yang XQ, You L, Zhang-Rui J (2007) Study of sleep quality in patients with psoriasis. Institute of Aviation Medicine. J Invest Dermatol 127:1809

  31. Preis SR, Massaro JM, Hoffmann U, D'Agostino RB Sr, Levy D, Robins SJ, Meigs JB, Vasan RS, O'Donnell CJ, Fox CS (2010) Neck circumference as a novel measure of cardiometabolic risk: the Framingham heart study. J Clin Endocrinol Metab 95:3701–3710. doi:10.1210/jc.2009-1779

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Pillar G, Shehadeh N (2008) Abdominal fat and sleep apnea: the chicken or the egg? Diabetes Care 31(Suppl 2):S303–S309. doi:10.2337/dc08-s272

    Article  PubMed  Google Scholar 

  33. Garvey JF, Pengo MF, Drakatos P, Kent BD (2015) Epidemiological aspects of obstructive sleep apnea. J Thorac Dis 7:920–929. doi:10.3978/j.issn.2072-1439.2015.04.52

    PubMed  PubMed Central  Google Scholar 

  34. Dalamaga M, Diakopoulos KN, Mantzoros CS (2012) The role of adiponectin in cancer: a review of current evidence. Endocr Rev 33:547–594. doi:10.1210/er.2011-1015

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Vgontzas AN (2008) Does obesity play a major role in the pathogenesis of sleep apnoea and its associated manifestations via inflammation, visceral adiposity, and insulin resistance? Arch Physiol Biochem 114:211–223. doi:10.1080/13813450802364627

    Article  CAS  PubMed  Google Scholar 

  36. Bonsignore MR, Eckel J (2009) ERS meeting report. Metabolic aspects of obstructive sleep apnoea syndrome. Eur Respir Rev 18:113–124

  37. Calvin AD, Albuquerque FN, Lopez-Jimenez F, Somers VK (2009) Obstructive sleep apnea, inflammation, and the metabolic syndrome. Metab Syndr Relat Disord 7:271–278. doi:10.1089/met.2008.0093

    Article  PubMed  PubMed Central  Google Scholar 

  38. Dempsey JA, Veasey SC, Morgan BJ, O'Donnell CP (2010) Pathophysiology of sleep apnea. Physiol Rev 90:47–112. doi:10.1152/physrev.00043.2008

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Zamarron C, Garcia Paz V, Riveiro A (2008) Obstructive sleep apnea syndrome is a systemic disease. Current evidence. Eur J Intern Med 19:390–398. doi:10.1016/j.ejim.2007.12.006

    Article  PubMed  Google Scholar 

  40. Steiropoulos P, Papanas N, Nena E, Antoniadou M, Serasli E, Papoti S, Hatzizisi O, Kyriazis G, Tzouvelekis A, Maltezos E, Tsara V, Bouros D (2010) Inflammatory markers in middle-aged obese subjects: does obstructive sleep apnea syndrome play a role? Mediat Inflamm 2010:675320. doi:10.1155/2010/675320

    Article  Google Scholar 

  41. Gupta MA, Simpson FC, Gupta AK (2016) Bidirectional relationship between obstructive sleep apnea (OSA) and psoriasis: implications for OSA therapies? J Clin Sleep Med 12:1309. doi:10.5664/jcsm.6142

    Article  PubMed  PubMed Central  Google Scholar 

  42. Gupta MA, Simpson FC, Gupta AK (2016) Psoriasis and sleep disorders: a systematic review. Sleep Med Rev 29:63–75. doi:10.1016/j.smrv.2015.09.003

    Article  PubMed  Google Scholar 

  43. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J (2000) Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 284:3015–3021

    Article  CAS  PubMed  Google Scholar 

  44. Schwartz AR, Patil SP, Laffan AM, Polotsky V, Schneider H, Smith PL (2008) Obesity and obstructive sleep apnea: pathogenic mechanisms and therapeutic approaches. Proc Am Thorac Soc 5:185–192. doi:10.1513/pats.200708-137MG

    Article  PubMed  PubMed Central  Google Scholar 

  45. Gowda S, Goldblum OM, McCall WV, Feldman SR (2010) Factors affecting sleep quality in patients with psoriasis. J Am Acad Dermatol 63:114–123. doi:10.1016/j.jaad.2009.07.003

    Article  PubMed  Google Scholar 

  46. Harsch IA, Schahin SP, Radespiel-Troger M, Weintz O, Jahreiss H, Fuchs FS, Wiest GH, Hahn EG, Lohmann T, Konturek PC, Ficker JH (2004) Continuous positive airway pressure treatment rapidly improves insulin sensitivity in patients with obstructive sleep apnea syndrome. Am J Respir Crit Care Med 169:156–162. doi:10.1164/rccm.200302-206OC

    Article  PubMed  Google Scholar 

  47. Weaver TE, Sawyer AM (2010) Adherence to continuous positive airway pressure treatment for obstructive sleep apnoea: implications for future interventions. Indian J Med Res 131:245–258

    PubMed  PubMed Central  Google Scholar 

  48. Vgontzas AN, Zoumakis E, Lin HM, Bixler EO, Trakada G, Chrousos GP (2004) Marked decrease in sleepiness in patients with sleep apnea by etanercept, a tumor necrosis factor-alpha antagonist. J Clin Endocrinol Metab 89:4409–4413. doi:10.1210/jc.2003-031929

    Article  CAS  PubMed  Google Scholar 

  49. Taylor-Gjevre RM, Gjevre JA, Nair BV, Skomro RP, Lim HJ (2011) Improved sleep efficiency after anti-tumor necrosis factor alpha therapy in rheumatoid arthritis patients. Ther Adv Musculoskelet Dis 3:227–233. doi:10.1177/1759720x11416862

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Author information

Author notes

  1. Evangelia Papadavid, Maria Dalamaga and Katerina Vlami contributed equally to this manuscript

Authors and Affiliations

  1. Second Department of Dermatology, Medical School, National and Kapodistrian University of Athens, Αttikon General University Hospital, 1 Rimini street, Haidari, 12468, Athens, Greece

    Evangelia Papadavid, Dimitra Koumaki & Dimitrios Rigopoulos

  2. Department of Clinical Biochemistry, Medical School, National and Kapodistrian University of Athens, Αttikon General University Hospital, 1 Rimini street, Haidari, 12468, Athens, Greece

    Maria Dalamaga & Gerasimos Socrates Christodoulatos

  3. Department of Biochemistry, National and Kapodistrian University of Athens, 75 Mikras Asias street, 11527, Athens, Greece

    Maria Dalamaga

  4. Second Department of Respiratory Medicine, Medical School, National and Kapodistrian University of Athens, Αttikon General University Hospital, 1 Rimini street, Haidari, 12468, Athens, Greece

    Katerina Vlami, Sotirios Gyftopoulos & Spyridon Papiris

Authors
  1. Evangelia Papadavid
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  2. Maria Dalamaga
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Corresponding author

Correspondence to Maria Dalamaga.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Papadavid, E., Dalamaga, M., Vlami, K. et al. Psoriasis is associated with risk of obstructive sleep apnea independently from metabolic parameters and other comorbidities: a large hospital-based case-control study. Sleep Breath 21, 949–958 (2017). https://doi.org/10.1007/s11325-017-1507-4

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