Sleep Disorders in Psoriasis and the Effect of Treatment on Sleep Quality: A Prospective Study in a Resource Poor...

Sleep disorders in psoriasis and their improvement with treatment have not been evaluated in the Indian subcontinent. The aim of the study was to assess the extent of sleep impairment and the effect of treatment on sleep impairment in patients with psoriasis.

This was a prospective, observational study with 59 participants of chronic plaque psoriasis, receiving standard non-biological treatment. Psoriasis Area Severity Index (PASI) score, 5D Itch Score, Pittsburg Sleep Quality Index, and Insomnia Severity Index were calculated at baseline, 4 weeks, and 12 weeks of follow-up. The primary outcomes were changes in sleep quality and insomnia at week 4 and week 12 compared to baseline.

Poor sleep quality and clinical insomnia were noted in 6 (10%) and 15 (25.4%) participants, respectively. Sleep quality was associated with body mass index ( P = 0.01) and pruritus ( P < 0.001), while insomnia showed an association with PASI ( P < 0.001). With treatment, poor sleep quality decreased to 5% at week 12 and this decrease was significant between weeks 4 and 12 ( P < 0.001). Insomnia decreased to 3.4% at week 12. This improvement was significant between baseline and week 4 ( P = 0.01) and between weeks 4 and 12 ( P = 0.005). The improvement in sleep quality had a positive correlation with a decrease in pruritus at 4 weeks ( P < 0.001) and 12 weeks ( P = 0.005).

Follow-up of 12 weeks only and missing values are drawbacks.

Sleep quality and insomnia improved with standard non-biological treatment and correlated with a reduction in psoriasis-induced pruritus. This finding is important as the treatment of psoriasis in resource-poor and developing countries mainly involves non-biological options.