Study Identifies Association Between Psoriasis, Sleep Disorders in National Cohort

Mild psoriasis is significantly linked to insomnia, restless leg syndrome, and obstructive sleep apnea, new findings suggest, although moderate-to-severe psoriasis demonstrated greater magnitudes of association with such sleep disorders.1

These findings and others resulted from a recent analysis that was conducted by investigators such as Michael J. Diaz, MD, from University of Florida, Gainesville’s College of Medicine. The study’s coauthors highlighted that severe psoriasis has been associated with increased sleep quality issues, especially among individuals living with intense inflammation and itch.

“Other factors such as race/ethnicity, socioeconomic status and comorbid conditions may further influence the presentation of [psoriasis] and its impact on sleep,” Diaz and colleagues wrote.1 “Accounting for this diversity is essential for developing tailored interventions that address the distinct needs and health disparities within the [psoriasis] community.”

The investigators explored data from the All of Us version 7 database, which includes approximately 45% racial and ethnic minority participants. Their analysis was conducted to identify patients who had a diagnosis of psoriasis.

Diaz et al noted that individuals who did not meet certain treatment thresholds were classified as having mild disease. Moderate-to-severe psoriasis was defined by the investigative team as having a history of systemic therapy use, including such drugs as methotrexate, psoralen, cyclosporine, or acitretin. They also included patients in this category who had used biologics such as infliximab, adalimumab, etanercept, ustekinumab, iixekizumab, secukinumab, brodalumab, bimekizumab, tildrakizumab, guselkumab, or risankizumab, or used phototherapy.

The team assessed links between psoriasis and a set of 5 sleep-related conditions: insomnia, restless legs syndrome (RLS), obstructive sleep apnea (OSA), REM sleep behavior disorder (RBD), and narcolepsy. They also used a 1:4 nearest-neighbor propensity score matching approach with the goal of controlling for age, sex, and race/ethnicity.

There were 7,473 adults with psoriasis that Diaz and colleagues identified, with the group's mean age being 62.6 years and 57.4% being female. Among these individuals, 1,935 (25%) were classified by the investigative team as having moderate-to-severe disease.

In their socioeconomic data, it was shown that 19.9% had annual incomes below $25,000, and 20.3% had never attended college. The findings suggest that racial distribution was similar between the study's different disease severity cohorts, with approximately 71.3% of mild cases and 71.4% of moderate-to-severe cases identifying as White.

A higher average body mass index (BMI) was observed amonng those with psoriasis versus the matched control arm of the study (P < .001). BMI was shown to be slightly higher among those with moderate-to-severe disease compared to subjects with mild disease.

Significant elevation in rates of anxiety and type 2 diabetes mellitus (T2DM) were also noted by Diaz and coauthors versus the control group—anxiety: 48.5% versus 30.6% (P < .001); T2DM: 30.2% versus 19.7% (P < .001). In their multivariable regression analysis, results indicated that subjects living with mild psoriasis had increased odds of experiencing insomnia (OR: 1.48; CI: 1.37–1.60), RLS (OR: 1.20; 95% CI: 1.05–1.37), and OSA (OR: 1.38; CI: 1.28–1.49), even after adjusting for anxiety, various demographic variables,T2DM, BMI, smoking, and chronic pruritus.

Such associations were shown by the investigators to be even more pronounced for trial participants with moderate-to-severe disease—insomnia: OR 1.74 (CI: 1.53–1.97); RLS: OR 1.64 (CI: 1.33–2.02); OSA: OR 1.81 (CI: 1.60–2.06). Neither psoriasis severity cohort demonstrated a statistically significant link to narcolepsy or REM sleep behavior disorder.

Odds of sleep disorder risks were further shown by the investigative team as highest among non-White patients, after they conducted their race- and ethnicity-stratified analysis.

“In sum, this analysis provides additional support for the PsO-sleep disorder association in a diverse adult population with robust covariate control,” they wrote.1 “Notably, none of the studies cited in our discussion stratified sleep outcomes by race/ethnicity as we have done. This stratification is crucial, as it reveals significant disparities in sleep disorder prevalence among PsO patients from different racial and ethnic backgrounds.”

References

1. Diaz MJ, Haq Z, Tran JT, et al. (2025). The Association of Psoriasis With Sleep Disorders in a Diverse National Cohort. JEADV Clinical Practice. https://doi.org/10.1002/jvc2.70022.

2. M Abrouk, K Lee, M Brodsky, et al. “Ethnicity Affects the Presenting Severity of Psoriasis,” Journal of the American Academy of Dermatology 77, no. 1 (2017): 180–182, https://doi.org/10.1016/j.jaad.2017.02.042.

3. E Mahé, A Beauchet, Z Reguiai, et al. “Socioeconomic Inequalities and Severity of Plaque Psoriasis at a First Consultation in Dermatology Centers,” Acta Dermato Venereologica 97, no. 5 (2017): 632–638, https://doi.org/10.2340/00015555-2625.