Sleep Disordered Breathing and Sleep Duration and the Risk of Psoriasis and Melanoma in the United States

Abstract

Sleep disordered breathing (snoring and obstructive sleep apnea (OSA)) has been associated with negative health outcomes including diabetes mellitus, cardiovascular disease, and reduced quality of life, presumably due to systemic inflammation. Long and short sleep duration have been associated with morbidity, all-cause mortality, and cancer-specific mortality. No large prospective studies exist to explore the relationship between sleep disordered breathing and sleep duration and psoriasis and melanoma risk.

This study prospectively evaluated the association between OSA and snoring and incident psoriasis in the Nurses’ Health Study (NHS; 1997-2008) and the association between sleep duration and melanoma risk in the NHS (1986-2012), NHS II (2001-2009), and Health Professionals Follow-Up Study (HPFS; 2000-2012). Cox proportional hazards were used to calculate age-adjusted and multivariate risk ratios.

Over the follow-up period, there were 524 cases of psoriasis among the women who were assessed for sleep apnea. Women with OSA were more likely to have a higher BMI, be hypertensive, work night shifts, and have type 2 diabetes mellitus. The age-adjusted relative risk (RR) of psoriasis among women with OSA was 2.19 (95% CI, 1.39-3.45). The multivariate RR adjusting for night shift work and hypertension, cardiovascular disease, and type 2 diabetes mellitus was 1.91 (95% CI, 1.20-3.05). There was no effect modification by BMI (p=0.52), hypertension (p=0.34), or snoring (p=0.91). Sleep apnea was not associated with an increased risk of psoriatic arthritis. Although women with sleep apnea were more likely to be snorers, we did not find a statistically significant relationship between snoring and psoriasis risk.

In the three cohorts, there was no relationship between sleep duration and melanoma risk. The multivariate RRs were 0.90 (95% CI, 0.67-1.20) for ≤6 hours, 1.30 (95% CI, 1.08-1.56) for 8 hours, and 0.76 (95% CI, 0.51-1.12) for ≥9 hours (p trend=0.09) in the NHS and NHS II and 1.08 (95% CI, 0.77-1.51) for ≤6 hours, 0.95 (95% CI, 0.69-1.30) for 8 hours, and 1.06 (95% CI, 0.68-1.67) for ≥9 hours (p trend=0.71) in the HPFS. In the NHS, there was no association between OSA and melanoma risk (RR 1.04 (95% CI, 0.42-2.55)) and there was also no association between snoring status and melanoma risk in the three cohorts.

In this prospective study, we found that OSA was associated with an approximately two-fold increased risk of psoriasis among US women and we found no association between sleep duration, sleep apnea, or snoring and melanoma risk among US women and men.