Measurement, Classification and Evaluation of Sleep Disturbance in Psoriasis: A Systematic Review.
BACKGROUND
Psoriasis is a long-term immune-mediated inflammatory disorder mainly, but not only, affecting skin, and is associated with significant medical and psychological morbidity. Evidence suggests that sleep is disrupted in psoriasis, however high quality empirical evidence is lacking. Given the importance of sleep for health, characterisation of sleep disruption in psoriasis is an important goal. We therefore conducted a systematic review of the sleep-psoriasis literature.


METHODS
Searches were conducted in Pubmed, SCOPUS and Web of Science from inception to May 2016. Studies were compared against inclusion/exclusion criteria and underwent a quality evaluation. Given the heterogeneity of studies, we conducted a narrative synthesis of the findings.


RESULTS
Searches revealed 32 studies which met our predetermined inclusion/exclusion criteria. Whilst 93.7% of studies reported sleep disruption in this population, ranging from 0.05% to 85.4%, many had important methodological shortcomings. Over half of all quantitative studies (54.8%; 17/31) relied on non-validated measures, contributing to heterogeneity in study findings. In those that employed valid measures, assessing sleep was often not the primary objective. We frequently found the absence of adequate sample size calculations and poor statistical reporting.


CONCLUSIONS
This review showed that in psoriasis, reported sleep rates of sleep disturbance varied substantially. Most studies lacked a hypothesis driven research question and/or failed to use validated measures of sleep. We were unable to draw firm conclusions about the precise prevalence and nature of sleep disturbance within the psoriasis population. We offer suggestions to help advance understanding of sleep disturbance in psoriasis.
Centre for Dermatology Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.|Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom.
Alasdair L
AL
Henry
Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
Simon D
SD
Kyle
Manchester Medical School, University of Manchester, Manchester, United Kingdom.
Sahil
S
Bhandari
Centre for Dermatology Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.|Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom.
Anna
A
Chisholm
Centre for Dermatology Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.|Salford Royal NHS Foundation Trust, Salford, United Kingdom.
Christopher E M
CE
Griffiths
Centre for Dermatology Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.|Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom.
Christine
C
Bundy
D006801:Humans; D015995:Prevalence; D011565:Psoriasis / Q000150:complications*; D012307:Risk Factors; D012890:Sleep; D012893:Sleep Wake Disorders / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology