Sleep Apnea and Skin
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SLEEP AND SLEEP APNEA AT THE EXTREMES (D GOZAL, SECTION EDITOR)
Sleep Apnea and Skin Vinaya Soundararajan 1 & Jennifer Lor 1,2 & Anna B. Fishbein 2 Published online: 25 August 2020 # Springer Nature Switzerland AG 2020
Abstract Purpose of Review Skin disease is associated with obstructive sleep apnea (OSA) both epidemiologically and mechanistically. In this review, we highlight conditions which have a well-established link to obstructive sleep apnea, such as psoriasis and atopic dermatitis. Recent Findings We describe putative mechanistic links between OSA and skin disease involving inflammatory pathways, obesity, mechanical upper airways obstruction, and hypoxia. In the context of these mechanisms, we describe specific skin conditions, and other conditions which are associated with both skin manifestations (including hair/nail findings) and OSA. The risks/benefits of CPAP in the context of skin disease are also reviewed. Summary We conclude that further research is needed to understand the mechanisms behind the associations between OSA and skin disease. Given the frequent co-occurrence of OSA and skin conditions, there would be great benefit for OSA clinical trials to consider improvement in skin disease as an outcome measure. Keywords Sleep apnea . Psoriasis . Atopic dermatitis . Sleep disturbance . Obesity
Introduction Skin diseases are a common comorbidity of sleep apnea, and sleep apnea itself can deteriorate the skin. In fact, one study found that post-treatment versus pre-treatment photos of obstructive sleep apnea (OSA) patients were deemed significantly more youthful and more attractive [1]. Indeed, beauty sleep is an appropriately coined term. As far as the epidemiologic association of sleep and skin, the Danish National Registry evaluated 19,438 patients with obstructive sleep apnea (OSA) compared to age-/gender-matched controls and analyzed comorbid diagnoses within 3 years of the OSA diagnosis. They found there were increased odds of skin conditions in OSA patients (OR 1.18 [1.07–1.30]) [2]. This finding was This article is part of the Topical Collection on Sleep and Sleep Apnea at the Extremes * Anna B. Fishbein [email protected] 1
Department of Internal Medicine, University of Illinois at Chicago, Chicago, IL, USA
2
Department of Allergy, Division of Pediatric Allergy & Immunology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University, 225 E. Chicago Avenue #60, Chicago, IL 60611, USA
also affirmed in a pediatric-only cohort from the same research group with an OR of 1.32, 95% CI 1.02 to 1.71 [3]. To dive into this association, we conducted a scoping review of the literature. The search was conducted in PubMed MEDLINE in November 2019 using a combination of keywords and Medical Subject Headings (MeSH), limited to English articles only. The following search strategy was used: (“Dermatology”[Mesh] OR “Skin”[Mesh] OR “Skin Diseases”[Mesh] OR skin OR dermat*) AND (“obstructive sleep apnea” OR “Sleep Apnea, Obstructive”[Mesh]) AND English[lang]. In our review of the
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