Sleep Disorders Associated With Dermatologic Conditions

Several dermatologic conditions are associated with sleep disturbances and disorders, including atopic dermatitis (AD) and psoriasis, predominantly due to severe itch and pruritus.

Kawee/AdobeStock

In a review,¹ researchers sought to compile data to provide an overview of sleep disorders associated with dermatology and certain dermatologic drugs which can lead to sleep disturbances, citing a suspected bidirectional influence between sleep disturbances or impairments and skin disease.

Researchers analyzed all articles published to PubMed Central from July 2010 to July 2022 using the key search term “sleep disorders in dermatology.” Other terms such as “itch,” “itch, sleep disturbances,” and “hematological malignancy” were also searched separately. Of 131 full texts identified, researchers narrowed their analysis to 72 articles for review. These included 11 clinical trials (of which 8 were randomized), 5 meta-analyses, 19 reviews (6 of which were systematic), and 37 contained associated data.

Beginning by analyzing the basic pathophysiology and biology of sleep disorders, researchers examined the normal sleep-wake cycle, circadian rhythm, sleep hormones, thermoregulation, immune function, and physiological components.

Psychological problems, researchers noted, can flare certain dermatologic conditions such as AD, psoriasis, or urticaria. They also noted that while insomnia may come as a result of exacerbated condition, it can also be a cause.

The review also highlighted the detrimental role of sleep loss on the body’s immune system, leading to the generation and release of inflammatory cytokines, which can lead to damage to the skin barrier function, infection, and some dermatologic diseases like non-healing ulcers. Some conditions like psoriasis, they found, impact heat regulation by making the body’s ability to dissipate heat more difficult.

In their research, several dermatologic conditions were associated with sleep disturbances and disorders, including:

• Atopic dermatitis
• Chronic urticaria
• Infections
• Pruritus/itch
• Psoriasis

They found that 47% to 80% of children with AD and 33% to 90% of adults experience sleep disturbances such as insomnia, particularly regarding difficulty falling and staying asleep. Additionally, certain drugs such as azathioprine, cyclosporine, and dupilumab not only reduced AD lesions but also reduced itch, leading to a significant reduction in sleep disturbances.

In patients with psoriatic arthritis (PsA)and psoriasis, issues in thermoregulation of the skin are common. Moreover, they are both associated with higher rates of fatigue, lower quality of life, higher rates of psychological problems, and sleep alteration compared to members of the general population. One study they cited found that 67% of patients with PsA and 52% with psoriasis experienced sleep disturbances, leading to fatigue during the day.

Sleep disturbance was reported in more than 50% of patients with chronic spontaneous urticaria, who also have a higher prevalence of psychological conditions. Researchers found that high doses of antihistamines led to improved sleep patterns.

Infections leading to nocturnal pruritus, and pruritus itself, also lead to sleep quality disturbances. Factors such as skin barrier function, transepidermal water loss, and body temperature, all play roles in nocturnal itching.

Of these, they also identified common sleep disorders related to dermatologic conditions:

• Narcolepsy
• Obstructive sleep apnea
• Parasomnias

“Sleep accounts for approximately one-third of a person's life. Skin diseases that cause sleep loss may be transient, long-term and/or recurrent and may lead to psychological complications. Treating the underlying skin condition can help treat the sleep disorder and vice versa,” study authors wrote. “After understanding the detrimental effects of sleep disturbance, clinicians need to consider sleep disturbance as an important comorbidity of skin disease and treat it accordingly to improve the quality of life of dermatologic patients. Sleep quality and duration can be measured for quality of life in chronic skin diseases. Maintaining a proper sleep cycle may help patients have better behavioral control during the day. The dermatologist should also focus on taking a specific history when evaluating a patient with chronic skin conditions, and therapy should be directed toward managing nighttime sleep quality.”

Reference

1. Mann C, Gorai S, Staubach‐Renz P, Goldust M. Sleep disorders in dermatology – A comprehensive review. J Dtsch Dermatol Ges. Published online 2023. doi:10.1111/ddg.14992