Original ArticleIncreased risk of psoriasis following obstructive sleep apnea: A longitudinal population-based study
Introduction
Obstructive sleep apnea (OSA) is a common form of sleep-disordered breathing characterized by repetitive episodes of partial or complete upper airway collapse during sleep, resulting in intermittent hypoxia and recurrent sleep arousals [1], [2]. Increasing evidence has shown that patients with OSA have a higher risk of various comorbid medical diseases, such as cardiovascular diseases, stroke, insulin resistance, and type 2 diabetes mellitus [3], [4], [5]. Although mechanisms underlying the link between OSA and these medical comorbidities remains to be elucidated, sympathetic overactivity, hypercoagulability, and activation of inflammatory pathways had been proposed as possible factors contributing to the associations [3], [6], [7]. Studies have shown that patients with OSA displayed a tendency toward local inflammation in the upper airway as well as oxidative stress and systemic inflammation, as indicated by elevated serum levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6, and C-reactive protein [8]. The inflammatory process may play an important role in the pathogenesis of atherosclerosis and insulin resistance in OSA [6], [9].
Psoriasis is a T-cell mediated inflammatory skin disease manifested clinically by scaly erythematous plaques, mainly occurring on the scalp, trunk, and extensor surfaces of the limbs [10]. Approximately 6–11% of patients with psoriasis may also have inflammatory arthropathy (psoriatic arthritis) [11]. Psoriasis could have a significant impact on health-related quality of life, comparable to that of other major medical diseases [12], [13]. Recent emergence of biologic targeting of inflammatory cytokine or its related molecules, such as TNF antagonists, has made a breakthrough in the successful treatment of moderate to severe psoriasis and psoriatic arthritis [14].
The activation of inflammatory pathways in patients with OSA may predispose them to the development of psoriasis. To date, data are limited regarding the association between OSA and psoriasis. Therefore, the objective of this study is to investigate the risk of psoriasis or psoriatic arthritis in patients with OSA compared with age- and gender-matched unaffected individuals using a nationally representative population-based dataset.
Section snippets
Database
This prospective case-control study used data sourced from the Taiwan “Longitudinal Health Insurance Database 2000 (LHID2000).” The LHID2000 includes all the original claim data and registration files for 1 000 000 beneficiaries, randomly sampled from the year 2000 Registry for Beneficiaries (n = 23.72 million) under the Taiwan National Health Insurance (NHI) program (the coverage rate of the Taiwanese population was over 98% in 2000). Taiwan initiated its Taiwan NHI program in 1996. The Taiwan
Results
Of the 13 513 sampled subjects, 8484 (62.2%) were male, with an overall mean age of 40.9 years ± 10.74 (standard deviation) (age range, 18–59 years). Table 1 presents the demographic characteristics for all sampled subjects stratified by the presence of OSA. After being matched for sex, age group, and the year of index ambulatory care visit, no significant difference existed between the study cohort and the comparison cohort in terms of monthly income (p = 0.084) in any geographic region. However,
Discussion
The study shows that patients with OSA had an approximately two-fold greater risk of developing psoriasis or psoriatic arthritis than the general population. While substantial research has demonstrated that OSA is comorbid with cardiovascular diseases and insulin resistance, our findings suggest that patients with OSA are also at a higher risk of incidence for psoriasis or psoriatic arthritis.
Intermittent hypoxia and oxidative stress in OSA is associated with the activation of pro-inflammatory
Conflict of interest
The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated with this article can be viewed by clicking on the following link: doi:10.1016/j.sleep.2011.07.018.
Acknowledgement
This study is based in part on data from the National Health Insurance Research Database provided by the Bureau of National Health Insurance, Department of Health, Taiwan and managed by the National Health Research Institutes. The interpretations and conclusions contained herein do not represent those of the Bureau of National Health Insurance, Department of Health, or the National Health Research Institutes.
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2018, Journal for Nurse PractitionersCitation Excerpt :One proposed mechanism is the activation of sympathetic nervous system and inflammatory pathways6,7,12,13,23 in that OSA and psoriasis are both inflammatory conditions that result in systemic inflammation and activation of the inflammatory pathways (eg, IL-6, tumor necrosis factor-α).6,23 Recurrent arousals during sleep in OSA may lead to the activation of sympathetic nervous system and further activate the inflammatory pathways, stimulating circulating levels of proinflammatory cytokines,22,23 and predispose patients to psoriasis or exacerbate symptoms of pruritus and pain.6,24,25 Recent studies showed that treatment of OSA with continuous positive pressure airway pressure (CPAP) improved psoriatic lesions and a decrease in tumor necrosis factor-α and IL-6 biomarkers.23,26