Patients with psoriasis more frequently display poor sleep quality and evening chronotype compared to healthy controls, and both factors are independently associated with greater disease severity, explaining 81% of the variance in PASI score.
Patients with psoriasis had significantly poorer sleep quality than healthy controls.
Patients with psoriasis had lower MEQ scores than healthy controls, indicating a tendency toward the evening chronotype.
Poor sleepers with psoriasis had significantly higher disease severity scores than good sleepers.
Evening chronotype patients had the highest PASI scores, exceeding both morning and intermediate chronotypes.
PASI score correlated significantly with multiple metabolic, inflammatory, and sleep-related measures.
Stepwise multiple regression identified MEQ score as the strongest independent predictor of PASI score, with the full model explaining 81% of PASI variance.
ROC analysis identified PSQI and MEQ score thresholds that predicted moderate-to-severe psoriasis, with MEQ showing higher accuracy.
Both poor sleep quality and evening chronotype were independently associated with greater psoriasis severity regardless of adiposity.
This research suggests that people with psoriasis are more likely to experience poor sleep and to be 'evening types' (night owls) compared to people without psoriasis. The study compared 213 adults with psoriasis to 213 healthy individuals matched for age and sex, measuring sleep quality using a standard questionnaire (PSQI) and natural sleep timing preferences using the Morningness-Eveningness Questionnaire (MEQ). Psoriasis patients scored worse on both measures, sleeping more poorly and tending to prefer later schedules. Within the psoriasis group, those who slept poorly had much worse skin disease — nearly five times the severity score compared to good sleepers. Strikingly, patients with an evening chronotype had the highest disease severity scores, far exceeding those with morning or intermediate chronotypes. When the researchers used statistical modeling, they found that evening chronotype (MEQ score) was actually the single strongest predictor of psoriasis severity, even after accounting for body weight, abdominal fat, inflammation, and smoking. Together, all these factors explained about 81% of the variation in disease severity. This research suggests that sleep timing and sleep quality are not just coincidental features of psoriasis but may be meaningfully linked to how severe the disease is. A very evening-leaning chronotype score (≤25 on the MEQ) identified patients with moderate-to-severe psoriasis with very high accuracy (nearly 99% sensitivity). These findings suggest that doctors managing psoriasis patients may benefit from routinely asking about sleep habits and natural sleep-wake preferences, as these factors could help identify patients at risk for more severe disease and potentially inform more personalized treatment approaches.
Verde L, Galasso M, Annunziata G, Megna M, Gallo L, Potestio L, et al.. (2026). The night matters: sleep quality and evening chronotype associated with clinical severity of psoriasis.. Frontiers in endocrinology. https://doi.org/10.3389/fendo.2026.1788526