Can Sleep Apnea Cause Psoriasis?

How is psoriasis connected to obstructive sleep apnea? You may think I'm crazy for even making the suggestion, but if you look at the studies, the results don't lie—you just have to connect the dots.

I've always wondered about this link, since almost every known medical condition is proven to be or possibly associated with obstructive sleep apnea. I was reminded about this connection when I read about golfer Phil Mickelson's psoriatic arthritis. I already commented on the association between sleep apnea and arthritis, and this time, I'm going to show you that psoriasis may be connected as well.

First of all, numerous studies have shown that people with psoriasis have a much higher chance of having cardiovascular disease. There are other reports that psoriasis is associated with an increased incidence of cancer, lymphoma, obesity, metabolic syndrome (also known as "Syndrome X"), autoimmune diseases (Crohn's disease and diabetes, etc.), psychiatric diseases (such as depression and sexual dysfunction), psoriatic arthritis, sleep apnea, personal behavior issues, chronic obstructive pulmonary disease (COPD).  If you have severe psoriasis, the likelihood that you'll have a heart attack is 3 times normal. Your chance of dying overall is almost doubled than if you didn't suffer from this condition. Average life expectancy is about 3 to 5 years shorter for someone with psoriasis.

We also know that obstructive sleep apnea can cause metabolic syndrome, hypertension, diabetes, high cholesterol, inflammation, heart disease, heart attack, and stroke. Your risk of dying early increases 45% if you have severe obstructive sleep apnea.

There's even a case report of someone with severe psoriasis who was completely cured after undergoing gastric bypass surgery for obesity.

Here's my take on the connection between obstructive sleep apnea and psoriasis: The chronic stress response and repeated episodes of hypoxia deprives the skin of vital blood flow and nutrients. Sympathetic activity overload preferentially shuts down certain parts of the body that are considered unessential, such as the digestive system, reproductive system, and the skin. In addition, chronic low-grade stress also causes your immune system to overreact and cause inflammation, inducing various self-destroying tendencies that are common with autoimmune conditions.

What do you think about this possible connection? I'd like to hear your opinion.

Please note: I reserve the right to delete comments that are offensive or off-topic.

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24 thoughts on “Can Sleep Apnea Cause Psoriasis?

  1. There are some clear associations and both diseases have inflammation and the stress response in common. Whether these factors are reduced in treating sleep apnea alone (or worsened if left untreated) or whether there is a dysregulation in the immune system caused by sleep apnea (actually causing psoriasis) is something that would require further investigation.

  2. I think that OSA, psoriasis, and a whole host of other diseases are brought about by our lifestyle stresses (lack of relationship, TV, foods tainted with insecticides and fed by inorganic chemicals, pollutions, little physical activity, and too much job stress) coupled with a lack of recovery mechanisms (good social life, great hobbies, proper job stress, good family life, excellent nutrition, good physical activities, great life honoring entertainment).

  3. Dan,

    None that I’m aware of. And there never will be. As long as we’re convinced that psoriasis is an autoimmune skin condition and obstructive sleep apnea is only seen in heavy snoring men with big necks, no one will ever try to prove a connection between then two.

  4. Hi Dr.Park,

    My father died few years ago and definitely a OSA patient and die of heart attach besides been a smoker for over 50 years and definitely have skin problems and treated by many skin doctors but each time just got worst for over the decades….3 signs (over weight, snorer, bad skin problems). Nobody understand what was the reason for such a bad skin problems with so many kind of treatments from surgery, steroids ….there is a very strong link between immune system was not been able to fight the inflammation which caused skin topica skin diseases.

    Malvin

  5. Dr. Park: I think you’re right on target with your observation concerning the connection between sleep apnea & skin diseases such as psorasis… I don’t have psorasis, however, ever since I was a teenager, I’ve had “bad skin” on my face, rosacea, & lots of inflamation -> Dematologists prescribed cortisone & other drugs – little help. Interestingly, last year, I started using CPAP and a dental device to treat my sleep apnea. FACT – My 30 yr. rosacea completely disappeared! I applaud you for continuing to educate us all about sleep apnea & the insidious things that go with it – too bad 99.9% of the medical community doesn’t posess your insight.

  6. The National Psoriasis Foundation funds some number of studies, if I recall correctly. Perhaps you could float the idea in a letter to the editor of their newsletter to see if anyone is interested in giving it a shot…

  7. Hi there,

    I am really intrigued by what this article suggests, here goes with some background info:

    …I have been suffering from psoriasis since 2003 in my early twenties. It started with a small spot on the back of my head and since then it has spread all over my body in patches. Lately (the last 2 years or so) the rate of new areas of my skin affected, has increased somewhat. Topical ointments are proving less effective. In addition, for the last year I have developed the arthritic form as well – specifically in my littles toes on my left foot and right knee (i have not had this diagnosed yet – but base it on the readings I have done and the fact that anti-inflammotories help when in severe pain).

    Apparently I have been snoring very loudly for quite a few years now – and my wife tells me that I am not breathing for a few seconds during my sleep as well. I am experiencing many of the symptoms associated with sleep apnoea – tiredness while driving / groggy / dry throat / throat feeling restricted. I am not overweight – but was very thin all my life until my early twenties when I started picking up some weight.

    So your article raises many questions for me as well….it was during reading up on sleep apnoea that I tried to see if any link exists between the 2….

    Since my GP provided some methods to sleep better (nasal spray/pump – to clear airways) – I have noticed that my skin is clearing up somewhat – on areas where I have had spots for more than a year continually. there has definitely been an improvement in my skin conditions since sleeping better. However, I still require the sleep condition to be treated more effectively (eg CPAP).

    regards,

    Jonathan – Cape Town, South Africa

  8. I am a 32 year old whit e female. I have psoriasis and have recently been diagonosed with sleep apanea. I have to see any improvement unless I was taking Methotrexate. Whie on that I stop iching and can sleep better. Last night was another story. Couldn’t get to sleep even with my cpap machine. I have agovernment job with is really stressful. I used to thrive on stressful situations now I guess it is killing me. Any help or suggestions

    Thanks
    angie

  9. Angie,

    I would think that your sleep apnea has to be treated definitively for any hope of improving your skin condition. People have various degrees of success using CPAP. Talk to your sleep doctor to make sure that you’re benefitting optimally from CPAP. Good luck.

  10. I came here to proove to myself that a relation between psoriasis and sleep apnea exists …

    Always watching very closely what happens to me, now looking backwards there HAS to be a relation;
    A few years back I started to develop psoriasis with some spots here and there and it doesn’t bother me really. However, all my nails are full with it either, THIS bothers a lot (mainly hands), and it’s a first thing which can’t be treated unless other life shortening stuff is applied. This is actually a good thing for observement, and finger nails easily get better and worse (so, hey, what happened ?).

    Because of not being able to drive a car because of falling asleep, I went to the hospital for that and was diagnosed severe aleep apnea (30 sec. interval) and was told I went there 5 years late.
    For almost 3 months I’m wearing cpap at night, and since 2 weeks or so I’m feeling quite recovered. Only TV watching won’t go yet, but otherwise no problems anywhere anymore.

    Also since these same two weeks for the first time I started to believe that the psoriasis on my nails really could go away (which I often thought at first but it never happend so I stopped thinking that). Right now I only wouldn’t show my thumb nails but further all is quite back to the “character” finger nails will show (about your own).

    I just have been waiting till the day I could find a relation with *something* from the psoriasis angle, and I can tell you that after using the cpap for a few days only, I felt sure it made me normal again, not quite knowing anymore what normal is, because the sleep apnea slowly deteriorates … ehhm … EVERYTHING ? And so throughout these few months only I already started to think about the psoriasis and that it HAD to go away, also feeling that bad sleep (which I perceivedly didn’t suffer from at all !) would just be killing to any (chemical) body process.

    For me it may be a long shot to think that wile brains are at rest, there’s time for physical body recovery (controlled by the brain as well), but which could be “micro attention” not being able to get priority while not being at complete rest (deep sleep stage).

    Right now I’m in the stage of wanting to help all those people actually suffering from sleep apnea without them knowing it, but which by now is so easy to diagnose by just me, having the experience. The experience of doing all I could myself before being diagnosed sleep apnea, to avoid snorring and e.g. wake up in the morning in the exact same position as I went to sleep the night earlier. I was CONVINCED I slept well, even very well. Wasn’t tired either but couldn’t drive a car. It only took me watching my own graphs of how I actually slept.
    It goes completely unnoticed while I tried to hard.
    That in the mean time another group of partners will be helped by not suffering from snorring from the other, would be a nice bonus …

    I would love to work this out further by email or otherwise, and make science of it when possible – and of course while I’m still a victim, which hopefully won’t last long anymore. Please contact me if you think it can be useful.

    Peter (52)

  11. I use to have hand dermatitis or hand eczema that never cleared up completely for several years. A Doctor of Dermatology told me my hands were touching something daily that I was allergic to and it was my job to figure out what I’m allergic to.

    After receiving a Bi-PAP around 2/1/11 and using it for a month I noticed the hand eczema is gone, but if I skip a night or two without using the Bi-PAP, my right middle finger near the tip will start to have dermatitis symptoms.

    I’m convinced that my hand skin suffers when sleep apnea deprives my body of oxygen.

  12. I have both moderate to severe psoriasis and sleep apnea. I am not overweight, if anything, I am a little underweight. I do believe the two play off each other. I try to use my cpac but then, I can’t sleep well. I do have high blood pressure and chronic pain syndrome. Maybe all of things are related.

  13. My husband developed psoriasis approx 11 years ago. It too started with a few spots and is now on both knees, elbow, tailbone area and both sets of fingernails. He also was diagnosed with atrial flutter around the same time and now has a pacemaker.
    And “guess what”, he was diagnosed last year with sleep apnea after years of snoring. Also 2 years ago he developed PMR or polymylagia rhuemtica.
    He has been on CPAP for also 1 year and there is no improvement in his psoriasis. My husband is not an overweight man.
    I agree there is a connection with sleep apnea, psoraris and heart disease. Doctors must make this connection on a daily basis with their patients.
    Dr park I applaud you for taking all health issues of an individual into consideration and seeing the connections!

  14. Wow. I was recently diagnosed with severe obstructive sleep apnea, and just started on a CPAP machine this week. I’m quite fair-skinned, and I’ve battled with rosacia, psoriasis and general skin conditions for years.
    I’m noticing an improvement in my skin after only 4 nights! I’m hopeful that my skin will keep improving as I continue my CPAP treatment.

  15. I’ve been diagnosed with mixed sleep apnea. Had a mild case of psoriasis (some patches on my legs which have all disappeared completely since using a nasal inhaler (albuterol) to open my airways. I stopped using albuterol and switched to CPAP and have noticed the psoriasis has still stayed clear.

    Caveat:
    I don’t think our symptoms are the result of bad sleep and if we cure the sleep, we cure the symptoms. I think we sleep to cope with stress. Less stress means we sleep more soundly and have less apnea. More stress means the opposite. I have no doubt the sleep machine has eased a lot of my physical symptoms, but I do not wake up well rested and refreshed. I wake up stressed out and tense. Like my body was physiologically repaired, but my mind went on an emotional roller coaster ride. I think it’s very important to be getting behavioral therapy if you decide to improve your sleep so you have coping mechanisms to depend on when you start making changes to how you sleep. You might clear your psoriasis to discover you have a whole new set of challenges to overcome.

  16. I’ve had worsening psoriasis starting in my mid-teens. (I’m now 51.) I’ve experimented with all kinds of medications, diet and environment changes with no significant long-term improvement. I had spinal fusion and started using a CPAP machine about 4 months ago, though the two are unrelated. Since then, something has caused drastic improvement in a few of my worst patches of psoriasis on my knees and side. They’re still a little red and thickened, but the plaque is gone. My elbows, groin and some other areas are still pretty bad, but this is the first significant improvement I’ve ever had so I’m thrilled about that. I don’t know that the CPAP treatment for my moderate apnea has caused the improvement, but it should definitely be investigated further.

  17. This is an interesting article that spurred me to do some digging. (My husband suffers from both sleep apnea (untreated) and psoriasis that is refractive to topical creams.) I came across a couple of studies that might be of interest.

    First, a study which found that Obstructive Sleep Apnea subjects not only had elevated baseline levels of TNFa and IL6 compared to controls, but also that the levels of TNFa spike considerably immediately after apnea events causing SaO2 levels to drop <85% (from a base TNFa of 9.7 pgML to 26.9). The authors suggest that this could partially be explained by hypoxia. They cytokine levels of OSA patients as compared to controls is described as being indicative of a Th1-type cytokine pattern. Similar results are found in non-OSA obese patients but at lower levels.
    http://www.ncbi.nlm.nih.gov/pubmed/14633242

    Second, a study that found levels of many cytokines including but not limited to TNFa and IL6 were higher in active psoriasis patients than in controls. "The pattern of cytokine expression suggests that Th1 cells may mediate or maintain disease [12, 13, 14]. Our data confirmed previously published data that the Th1 cytokines (TNF-α, IFN-γ, and IL-12) and some proinflammatory cytokines (such as IL-6, IL-8, and IL-18) are influenced in the serum of psoriatic patients. Moreover, we found significant correlation between severity of the disease and serum levels of IFN-γ, IL-12, IL-17, and IL-18."
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1533889/

    Third, a report/survey of Hyperbaric Oxygen Therapy (HBOT) in psoriasis in which two patients were greatly improved by HBOT and the mechanisms for the use of HBOT in inflammatory diseases.
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2737769/

    IL6 and TNFa levels have also been found to be elevated in people with high anxiety/chronic stress, and those levels have been found to be lowered by regular yoga practice, though the mechanisms for this are unclear. Does the movement and deep breathing increase circulation and oxygenation??

    Is it possible that hypoxia caused by OSA triggers cytokine storms that, over time, build up into chronically high levels that tip a patient into T1 immune status and lead to autoimmune disorders like psoriasis? And that reversal of chronic hypoxia (whether through CPAP, HBOT, or yoga breathing) can help to lower the levels and thereby restore T1/T2 balance, causing the symptoms to abate?

  18. I have been diagnosed with severe sleep apnea for 6 years now nothing work. I had the throat and palette surgery didn’t help. I have had severe psoriasis for about 6 years My last sleep study was three weeks ago with a new doc in Portsmouth Ohio a great doc by the way. After the test witch I had really bad results actually incredible my heart didn’t stop or Chang the beat I lade flat on my back so they could tell how bad it was the doc said my blood oxygen level dropped to 53% witch is hard to read that low I stopped breathing 117 times an hour. I know I have had horrible sleep apnea for years crazy right well that misery was brought on by a company called WREN CARE what a joke anyone who has sleep apnea save your life time money go somewhere else they are horrible.
    Now I receive my new bi-pap a week later it’s been two weeks and I feel amazing my psoriasis is starting to clear up and I feel more like myself again I had no idea how bad I had gotten this is truly a new life

  19. Hi Doctor Park, I am from the UK, I have only just discovered your website which appears to date back from 2009? when you first brought OSA & RA together, so firstly can you PLEASE bring me up to date with your latest findings. For me this is so exciting and here’s why.
    I was first diagnosed with RA 10 years ago. Having spent 2 yrs following the conventional doctors style treatment (suppressing the immune system) I then decided to follow my own instincts and research RA for myself. I first found that my pain (especially at night) appears to be caused by a lack of oxygen in my body. After trying many natural supplements i discovered organic sulfur crystals, which helped the pain over around a 3 year period. when it slowly began to not help anymore. (for the last 3 years) I now have an added problem of psoriasis and urticaria and just a month or two ago i had my GP check my uncontrollable daytime tiredness! which resulted in them finding I have severe OSA (stopping breathing 45 times every hour) for the last 2 weeks I have been treated using CPAP. . I am still getting to grips with the treatment so not yet feeling any real benefit. but i am convinced that this problem of sleep apnea has been with me for many years, and only just been discovered. I truly believe there may well be a connection with my RA/psoriasis due to my body’s lack of oxygen! because of OSA.
    Just for your information I have never been overweight and I am 67 years old.

  20. Hi
    I have suffered from Sleep Apnea since I was about 18 (I’m 27 now) and I started on CPAP about 3 years ago. About the same time as I started with CPAP I developed Psoriasis. Psoriasis is a hideous thing to have to deal with. But I definitely notice a link between having several bad nights with the SA and my skin flaring up. Interesting to see that there may be a medical link. Thank you for your insight!

  21. Hello Dr. Park,
    I just came across your website and read this interesting topic. I’m in my early 40s and I suffer from both moderate plaque psoriasis and moderate OSA. My psoriasis condition has only worsened over time from when I was a teenage to now. Your comment about a chronic stress response makes a lot of sense to me since I feel like my body has been under attack for quite some time now – I wish I knew what was going on with my sleep sooner! I am just starting to get proper treatment for my sleep apnea. I real bonus for me to fix my sleep problem and gain back new levels of energy would be to also improve my skin appearance.
    There is a 2015 study from Denmark that concludes the following:
    Psoriasis was associated with increased risk of sleep apnea, and sleep apnea was associated with increased risk of psoriasis. The clinical significance of this bidirectional relationship warrants further study.
    https://www.ncbi.nlm.nih.gov/pubmed/26715401
    Have you seen any new information to confirm this coorelation?
    Thanks,
    Mark