Associations of Sleep Pattern and Genetic Risk with Late-Onset Psoriasis: A Large Prospective Cohort Study

Whether sleep disturbance is associated with the risk of incident psoriasis, and whether this association exists in the presence of different genetic risk levels remain unknown. To examine the sleep-gene interaction in association with risk of psoriasis, we conducted a prospective cohort study that recruited >500,000 participants from 2006 to 2010 using data from the UK Biobank. A sleep pattern was defined by chronotype, sleep duration, insomnia, snoring, and daytime sleepiness and was categorized into 3 groups. In addition, we constructed a weighted genetic risk score of psoriasis and also categorized it into 3 genetic risk groups. We assessed whether there was an interactive effect between the sleep pattern and genetic factors on psoriasis risk. Our results identified that poor sleep pattern was associated with a significantly higher risk of developing psoriasis (hazard ratio = 1.656, 95% confidence interval [CI] = 1.403-1.954, P < .001) compared with ideal sleep pattern, and the effect size was much more pronounced among the female participants (hazard ratio = 2.050, 95% CI = 1.646-2.554, P < .001). The joint effects of sleep pattern and genetic risk was greater in participants with high genetic risk and poor sleep pattern group (hazard ratio = 3.620, 95% CI = 1.671-4.907, P < .001). An interaction effect was detected between sleep pattern and genetic risk, and the population attributable fraction of sleep pattern (49.0%, 95% CI = 40.0-56.6, P < 0.001)) was comparable with genetic risk (50.0%, 95% CI = 44.6-54.8, P < .001)). Altogether, we confirmed that poor sleep pattern increases the risk of incident psoriasis, particularly among the female population.