title: Concomitant Sleep Disorders Significantly Increase the Risk of Cardiovascular Disease in Patients with Psoriasis.
abstract: BACKGROUND
  The increased rates of cardiovascular morbidity and mortality in patients with psoriasis are not adequately explained by traditional risk factors. Whether concomitant sleep disorders (SDs) modify the risk of cardiovascular disease (CVD) in patients with psoriasis remains unknown.
  
  
  METHODS
  Using the Taiwan National Health Insurance Research Database (NHIRD), we conducted a cohort study to investigate the association between concomitant SDs and CVD risk in patients with psoriasis. Data from 99,628 adults who received a psoriasis diagnosis during the period from 2004 to 2010 were analyzed. Cox proportional hazards regression analysis models were used to compare the risks of ischemic heart disease (IHD) and stroke between patients with and without SDs.
  
  
  RESULTS
  Psoriasis patients with a concomitant SD had significantly higher risks of IHD (adjusted hazard ratio [aHR], 1.25; 95% confidence interval [CI], 1.22-1.28) and stroke (aHR, 1.24; 95% CI, 1.16-1.33) as compared with psoriasis patients without SDs. All psoriasis patient subgroups, including those with mild and severe psoriasis and those with and without arthritis, had increased HRs for IHD and stroke. The increases in IHD and stroke risks conferred by SDs were proportional to the dose of hypnotics used. The effect of SDs on the risks of IHD and stroke was greater in young adults than in middle-aged and older adults.
  
  
  CONCLUSIONS
  The risks of IHD and stroke were higher for psoriasis patients with SDs than for those without SDs. Clinicians should carefully evaluate CVD risk, particularly in young patients with psoriasis.
authors.affiliation: Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan.|Department of Dermatology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.|Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Hsien-Yi
authors.initials: HY
authors.lastname: Chiu
authors.affiliation: Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Chi-Feng
authors.initials: CF
authors.lastname: Hsieh
authors.affiliation: Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Yi-Ting
authors.initials: YT
authors.lastname: Chiang
authors.affiliation: Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Yi-Wen
authors.initials: YW
authors.lastname: Tsai
authors.affiliation: Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Weng-Foung
authors.initials: WF
authors.lastname: Huang
authors.affiliation: Department of Dermatology, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan.|Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Cheng-Yuan
authors.initials: CY
authors.lastname: Li
authors.affiliation: Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.|Division of Dermatology, National Taiwan University Hospital, Yun-Lin Branch, Dou-Liou, Taiwan.
authors.forename: Ting-Shun
authors.initials: TS
authors.lastname: Wang
authors.affiliation: Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Tsen-Fang
authors.initials: TF
authors.lastname: Tsai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001168:Arthritis / Q000150:complications / Q000473:pathology; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology* / Q000473:pathology; D016016:Proportional Hazards Models; D011565:Psoriasis / Q000150:complications / Q000473:pathology; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000150:complications* / Q000473:pathology; D055815:Young Adult