Hidradenitis Suppurativa and Psoriasis: Risks for OSA

sleep itch
sleep itch
This is the first prospective study to use formal sleep studies to assess the prevalence of obstructive sleep apnea in hidradenitis suppurativa.

Obstructive sleep apnea (OSA) was observed in 37.5% of patients with hidradenitis suppurativa (HS) and in 42.8% of patients with psoriasis, researchers reported in a study published in the British Journal of Dermatology.

The investigators recruited 36 patients (28 women) with HS and 31 patients (16 women) with psoriasis from May 2017 to February 2019 in a single center. Patients completed the Berlin, STOP-Bang, and Epworth Sleepiness Scale questionnaires, and all participants were invited for an overnight sleep study.

Half of the patients with HS and 34% of psoriasis patients had a high probability of OSA as assessed by the Berlin and STOP-Bang questionnaires. In addition, 41% of HS patients had an Epworth Sleepiness Scale score greater than 10 compared with 26.3% of psoriasis patients. Patients with more severe HS had a higher risk for OSA according to the STOP-Bang Questionnaire (odds ratio [OR], 4.6; P =.02).

A total of 16 of the 36 HS patients and 14 of the 31 psoriasis patients participated in the ambulatory sleep studies by undergoing overnight sleep apnea testing with Embletta™ or Nox T3™ polysomnography. The HS patients who participated in the sleep studies had a higher frequency of Hurley stage 3 (50% of attenders vs 15% of nonattenders; OR, 7.5; P =.01).

Among psoriasis and HS patients, those who participated in the sleep studies had a lower calculated risk for OSA compared with those who did not attend according to the STOP-Bang and Berlin questionnaires. Both the attender and nonattender groups had similar risk factors for OSA, including BMI and neck circumference.

The study authors found that 37.5% (6/16) of HS patients who participated in the ambulatory sleep studies and 42.8% (6/14) of psoriasis patients who participated in the ambulatory sleep studies had an apnea-hypopnea index greater than 5 and thus were diagnosed with OSA. There was a positive association between OSA positivity and Hurley stages 2 and 3 (r = 0.49; P =.05), and OSA positivity and Dermatology Life Quality Index values (r = 0.56; P =.03).

Participants with higher C-reactive protein levels were more likely to be at risk for OSA (P =.04). Patients with more severe HS also had a higher risk for OSA (OR, 4.6; P =.02). This relationship remained significant even after controlling for other risk factors.

“Our study demonstrates that the prevalence of OSA in HS patients is higher than suggested in epidemiological studies,” stated the study authors. “The uptake for full sleep studies was approximately 45% among psoriasis and HS patients. This may have been related to the requirement of an overnight admission or poor understanding of the nature of sleep apnea disease, its symptoms, and consequences among our patient cohort.”

The estimated prevalence of sleep apnea in the general population is approximately 10% in men and boys and 3% in women and girls. Patients who participated in the sleep studies had a lower risk for sleep apnea (based on screening questionnaires) compared with those who did not attend. “It is likely, therefore, that our study underestimates the incidence of sleep apnea in HS and psoriasis patients,” noted the investigators.

“We suggest that all patients with moderate to severe HS and psoriasis should be opportunistically screened for OSA using the STOP Bang and Berlin questionnaires to identify and treat a modifiable cardiovascular risk factor,” the researchers concluded.


Kelly A, Meurling J, Kirthi Jeyarajah S, et al. Obstructive sleep apnea in psoriasis and hidradenitis suppurativa. Br J Dermatol. Published online January 6, 2021. doi:10.1111/bjd.19802