Obstructive sleep apnea (OSA) and psoriasis are two seemingly unrelated conditions that affect millions of individuals across the globe. Psoriasis is a condition that causes itchy, dry and scaly rashes in the skin, while obstructive sleep apnea (OSA) is a condition where breathing slows down or stops repeatedly during sleep. However, recent studies suggest a deeper connection between the two than previously thought.

Psoriasis affects around 1-2% of the population and sleep apnea is commonly found. When two such conditions are common among the population, they often overlap.

Explaining how psoriasis can affect sleep by itself, Dr Ananya Sharma, senior resident dermatologist at All India Institute of Medical Sciences (AIIMS), Delhi, says, “Psoriasis can lead to troublesome symptoms like itching, skin tightness, scaling and shedding.” Furthermore, these symptoms can extend to moodiness, depression, anxiety and sleep disorders — leading to stress and reducing the quality of your sleep, says the doctor.

“While decreased sleep quality exacerbates stress, psoriasis is known to be triggered by stressful situations,” adds Dr Sharma.

Inflammation: Common link

Both sleep apnea and psoriasis are associated with abnormal inflammation in the body, affirms  Dr Tejas M Suri, pulmonary and sleep medicine specialist, Sitaram Bhartia Institute of Science and Research, New Delhi. When a person has OSA, there is an obstruction in the airways, leading to difficulty breathing. This obstruction makes it hard for the oxygen from the environment to enter the lungs and the bloodstream, leading to a repeated fall of the oxygen level in the blood and its return to normal. This results in the formation of oxygen-free radicals, which causes inflammation, which is a crucial factor behind other lifestyle disorders like cardiovascular problems, stroke, diabetes as well as psoriasis, he added.

He elaborates on how population studies from Western nations suggest that individuals with psoriasis may have twice the odds of developing sleep apnea and vice versa. Whether it is a causative relationship or a mere association — the exact mechanism behind this remains unclear, he added.

Psoriasis and sleep apnea have a bidirectional link, says Dr Sharma, adding, “Psoriasis is an inflammatory skin disorder that leads to hyperactivation of the immune system. This inflammation increases the release of cytokines (signaling proteins that regulate inflammation) in the body, which is also the case with sleep apnea.”

Managing and treating OSA and psoriasis

While psoriasis is known to be associated with obesity, metabolic syndrome, diabetes and hypertension—these are risk factors for obstructive sleep apnea as well, say experts. 

To add to that, Dr Suri says, “In individuals with sleep apnea, the airway tends to get blocked due to the fat deposition in the neck because of being obese or overweight.”

Therefore, maintaining a healthy body weight, inculcating regular physical exercise, practicing calming techniques like meditation, and having a balanced diet are crucial to improving the conditions for someone susceptible to encountering OSA or psoriasis, along with the ones dealing with them.  

Treating psoriasis

• Antihistamines: To address dryness and control the itch, as recommended by doctors.
• Soothing creams: Soothing lotions and ointments that calm the skin, decrease itching and improve sleep quality.

Treating sleep apnea

• CPAP/BiPAP machines: For those with breathing troubles, Continuous Positive Airway Pressure (CPAP) and Bi-level Positive Airway Pressure (BiPAP) devices push air into the airways with positive pressure and open the lungs to facilitate seamless breathing.
• Lifestyle changes: Regular physical exercise, a healthy diet, quitting smoking, reducing alcohol consumption, practicing calming techniques like meditation and achieving a normal body weight.

Takeaways

• Psoriasis and OSA have a bidirectional relationship, with inflammation being their common denominator.
• Individuals with psoriasis may have twice the odds of developing sleep apnea and vice versa.
• Both psoriasis and OSA are known to be associated with risk factors like obesity, metabolic syndrome, diabetes & hypertension.
• Maintaining a healthy body weight with regular physical exercise & having a balanced diet are crucial to deal with both these conditions.