Measurement, Classification and Evaluation of Sleep Disturbance in Psoriasis: A Systematic Review

Abstract

BackgroundPsoriasis is a long-term immune-mediated inflammatory disorder mainly, but not only, affecting skin, and is associated with significant medical and psychological morbidity. Evidence suggests that sleep is disrupted in psoriasis, however high quality empirical evidence is lacking. Given the importance of sleep for health, characterisation of sleep disruption in psoriasis is an important goal. We therefore conducted a systematic review of the sleep-psoriasis literature.MethodsSearches were conducted in Pubmed, SCOPUS and Web of Science from inception to May 2016. Studies were compared against inclusion/exclusion criteria and underwent a quality evaluation. Given the heterogeneity of studies, we conducted a narrative synthesis of the findings.ResultsSearches revealed 32 studies which met our predetermined inclusion/exclusion criteria. Whilst 93.7% of studies reported sleep disruption in this population, ranging from 0.05% to 85.4%, many had important methodological shortcomings. Over half of all quantitative studies (54.8%; 17/31) relied on non-validated measures, contributing to heterogeneity in study findings. In those that employed valid measures, assessing sleep was often not the primary objective. We frequently found the absence of adequate sample size calculations and poor statistical reporting.ConclusionThis review showed that in psoriasis, reported sleep rates of sleep disturbance varied substantially. Most studies lacked a hypothesis driven research question and/or failed to use validated measures of sleep. We were unable to draw firm conclusions about the precise prevalence and nature of sleep disturbance within the psoriasis population. We offer suggestions to help advance understanding of sleep disturbance in psoriasis.

Understanding the experience of sleep disturbance in psoriasis: a qualitative exploration using the Common‐Sense Model of Self‐Regulation

“…5 Mounting evidence suggests links between psoriasis and sleep disturbance. 6 Recent research indicates that sleep disturbance is common in psoriasis, characterized by difficulties initiating and maintaining sleep, early waking and an inability to resume sleep, as well as short sleep duration (< 7 h). 7 Itch, pre-sleep cognitive and somatic arousal, depression and pain have been associated with sleep disturbance in psoriasis.…”

“…7 Itch, pre-sleep cognitive and somatic arousal, depression and pain have been associated with sleep disturbance in psoriasis. [6][7][8][9][10] Sleep has an important role in the functioning of physiological and psychological systems. 11 Beyond the noticeable consequences of sleep disturbance (e.g.…”

“…Aside from characteristic demarcated plaques and other dermatological sequelae, psoriasis is associated with significant comorbidity, namely, diabetes, psoriatic arthritis, cardiovascular disease, and depression and anxiety . Mounting evidence suggests links between psoriasis and sleep disturbance . Recent research indicates that sleep disturbance is common in psoriasis, characterized by difficulties initiating and maintaining sleep, early waking and an inability to resume sleep, as well as short sleep duration (< 7 h) .…”

“…Recent research indicates that sleep disturbance is common in psoriasis, characterized by difficulties initiating and maintaining sleep, early waking and an inability to resume sleep, as well as short sleep duration (< 7 h) . Itch, pre‐sleep cognitive and somatic arousal, depression and pain have been associated with sleep disturbance in psoriasis . Sleep has an important role in the functioning of physiological and psychological systems .…”

Psoriasis and sleep: unravelling the relationship

“…The relationship appears to be bidirectional, and the complexity in the relationship is illustrated by evidence for a role for sleep disturbance in the relationship of psoriasis with ischaemic heart disease and stroke . In trials of biologics, improvements in psoriasis have been accompanied by improvements in sleep parameters …”