SUBJECTIVE SLEEP QUALITY IN PSORIATIC PATIENTS AND ITS ASSOCIATION WITH SYMPTOMS SEVERITY

Introduction: Psoriasis is a prevalent dermatological condition frequently associated with sleep disturbances. Evidence suggests a bidirectional relationship between sleep impairment and psoriatic symptoms, creating a vicious cycle that significantly impacts quality of life. This study investigated the subjective quality of sleep among patients diagnosed with psoriasis with mild symptom severity. The main aim was to determine the relationship between self-reported sleep quality and the perceived severity of psoriasis symptoms. Materials and methods: Psoriatic patients were recruited from Dermatology Units based on the following criteria: 18–65 years, mild symptom severity (PASI< 10; DLQI< 5), no systemic treatment (topical only), absence of comorbid medical conditions (including psychiatric and sleep disorder diagnoses), no history of drug or alcohol abuse, limited caffeine (no more than 150 mg/day) and alcohol (no more than 250 mL/day) consumption. Control participants were recruited via social media and advertisement following the same inclusion criteria except for the presence of psoriatic disease. Participants filled out the Pittsburgh Sleep Quality Index (PSQI), addressing habitual sleep quality across seven subscales (i.e., subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disorders, sleep medication use, daytime dysfunctions due to sleepiness), with higher scores indicating poor sleep quality. Participants were also required to complete a 10-item Numeric Rating Scale for 7 consecutive days to report psoriasis-related levels of itch and pain at bedtime and upon awakening. Additionally, participants completed a set of questionnaires exploring anxiety (Beck Anxiety Inventory; BAI) and depression symptoms (Beck Depression Inventory; BDI), habitual sleepiness (Epworth Sleepiness Scale; ESS), and Quality of Life (SF-36 questionnaire). Results: Nineteen patients (12M, 7F; age = 37.89±12.93) and 53 controls (14M, 39F; age = 28.33±13.29) were recruited. No between-groups differences emerged in PSQI scores nor in BAI, BDI, ESS, and SF-36 scores. Patients’ PSQI total scores exhibited a positive correlation with the level of itch and pain referred at bedtime (itch: ρ=.608; p=.006; pain: ρ=.613; p=.005) and risetime (itch: ρ=.568; p=.110; pain: ρ=.594; p=.007). As for PSQI subscales, level of itch and pain, both at bedtime and risetime, positively correlated with subjective sleep quality (bedtime: itch: p=.019; pain: p=.023; risetime: itch: p=.040; pain: p=.021), sleep latency (bedtime: itch: p=.048; pain: p=.050; risetime: itch: p=.049; pain: p=.014) and daytime dysfunction (bedtime: itch: p=.046; pain: p=.044; risetime: itch: p=.015; pain: p=.016). Moreover, patients’ PSQI total score correlated with the SF-36 subscale of Physical functioning (p=.024), Fatigue ( p=.014), and emotional well-being (p=.012), and with BAI scores (p=.019). Conclusions: This study explored subjective sleep quality in psoriatic patients, focusing on the level of itch and pain intensity as key indicators of self-reported disease burden. Our findings revealed that poorer subjective sleep quality was positively correlated with perceived psoriasis symptoms. This result highlights the relevance of addressing sleep quality in psoriatic patients, even when symptom severity is low. Optimizing sleep emerges as a key factor in overall patient well-being and potentially contributes to a more effective and comprehensive management of the disease. Funded by the European Union – Next Generation EU, Mission 4 Component 1 CUP B53D23003440006