Sleep and the gut microbiome in psoriasis: clinical implications for disease progression and the development of cardiometabolic comorbidities

Abstract

Background: Sleep dysfunction and sleep disorders are important comorbidities of psoriasis. Not only do these sleep comorbidities contribute to reduced quality of life, but they may also lead to worsening psoriasis and increased susceptibility to cardiometabolic diseases. While psoriasis and sleep dysfunction are thought to be linked by itch, depression, and immune system dysregulation, the relationship between psoriasis and sleep dysfunction is not yet fully understood.

Objective: We sought to compare previous studies characterizing the gut microbiome in psoriasis and sleep dysfunction and examine the potential relevance of shared findings on cardiometabolic and overall health.

Methods: We performed literature searches of PubMed and Embase databases to find studies evaluating the gut microbiome in psoriasis, sleep dysfunction, and cardiometabolic diseases.

Results: Studies characterizing the gut microbiome in psoriasis and sleep dysfunction reveal shared findings, specifically an increased Firmicutes to Bacteroidetes ratio and reduced abundance of short chain fatty acid-producing bacteria. These dysbiotic features have also been shown to promote systemic inflammation and cardiometabolic disease.

Conclusion: In favoring an increased Firmicutes to Bacteroidetes ratio and reduced abundance of short chain fatty acid-producing bacteria, sleep dysfunction could be contributing to worsening psoriasis and cardiometabolic comorbidities through intestinal dysbiosis. Future studies are needed to determine whether gut- and sleep-targeting interventions could be therapeutic in psoriasis patients with poor sleep.

Keywords: dysbiosis; flora; insomnia; microbiome; microbiota; obstructive sleep apnea; psoriasis; sleep deprivation; sleep disorder; sleep dysfunction.

Figure 1 legend:

PRISMA-based flow-chart of search for studies included in review.

Figure 2 legend:

Effects of an elevated F/B ratio and decreased SCFA-producing bacteria on cardiometabolic health and psoriatic disease. Psoriasis and sleep dysfunction have both been demonstrated to promote intestinal dysbiosis, partially characterized by an 1) increased F/B ratio and 2) reduced SCFA-producing bacteria within the gut. 1A) An increased F/B ratio is associated with high TMAO production, which is linked to greater risk of cardiovascular disease. 1B) An increased F/B ratio promotes obesity and insulin resistance, in part due to its influence on carbohydrate metabolism. 2A) Loss of butyrate, an anti-inflammatory SCFA, permits a chronic, low-grade inflammatory state, impairing the integrity of the gut epithelial barrier. This allows for bacterial DNA and other antigens to translocate from the gut to systemic circulation, where they may act to trigger an immune response at distant sites, such as skin and joints.