Rosacea, Poor Sleep Quality, and Obstructive Sleep Apnea May Be Connected

Nerve pain is often worse at night, causing difficulty sleeping. Patients may be hypersensitive, reporting discomfort from the touch of sheets or the pressure of lying down.
Nerve pain is often worse at night, causing difficulty sleeping. Patients may be hypersensitive, reporting discomfort from the touch of sheets or the pressure of lying down.
Sleep disturbance, especially obstructive sleep apnea, as a possible trigger for rosacea is investigated.

A possible relationship between rosacea and sleep complaints has been suggested, and the effect of obstructive sleep apnea in particular should be considered, according to study data published in the Journal of Cosmetic Dermatology.

Sleep disruptions can cause dysregulation of the body’s physiology which can exacerbate the clinical course of rosacea, the study authors explained. The classic burning sensation noted by patients with rosacea is strongly correlated with bodily temperature changes. “Poor sleep…can lead to temperature dysregulation in the human body, in addition to an increased release of catecholamines,” the researchers wrote. An increased temperature and vasodilatation in the face as a result of sleep disturbances, they suggested, is a possible aggravator of rosacea.

A study with 608 patients with rosacea and 608 control participants found that the severity of rosacea was closely associated with poor sleep. The study used the Pittsburgh Sleep Quality Index (PSQI), a questionnaire that monitors self-reported sleep, which found poor sleep quality in more than half of the patients with rosacea group. An experimental study found that sleep deprivation affected the rosacea-like phenotype in mice, the investigators explained, and an animal model study showed that a consequence of sleep disorders is the greater release of inflammatory cytokines, which may cause the development and worsening of chronic systemic comorbidities like rosacea.

Although there are connections between general sleep distress and rosacea, this study highlights the importance of considering the effects of obstructive sleep apnea (OSA) on rosacea. OSA is linked with greater sympathetic activation and an increased release of catecholamines, the researchers wrote, which can affect the facial vasculature and trigger rosacea. They cited a retrospective study which concluded that patients with rosacea have an increased risk of experiencing sleep apnea, suggesting a connection between these disorders. Furthermore, studies have shown that rosacea is strongly correlated with cardiometabolic problems, including hypertension, dyslipidemia, and obesity. These comorbidities are also seen in patients with OSA, which the researchers believe points to another link between OSA and rosacea.

Rosacea severity can also be connected to OSA through OSA-induced impairment of the gut microbiome; OSA-related hypoxia can lead to a hypoxemic state that affects bowel vasculature. Studies support this hypothesis by showing that rosacea could be related to gastrointestinal disorders and modified bowel microbiota. All of this suggests to the investigators that rosacea may be multisystemic, making it more complex than a simple skin disease and requiring more research into its connection with sleep.

Based on the collected information and data presentation, the researchers concluded that, “As good sleep is a crucial factor to the regulation of homeostasis, future research should aim to better understand this possible circular relationship between sleep disturbances, particularly OSA, and rosacea.”


Xerfan EMS, Andersen ML, Facina AS, Tufik S, Tomimori J. Rosacea, poor sleep quality, and obstructive sleep apnea: A commentary on potential interconnected features. J Cosmetic Dermatology. January 28, 2022.doi:10.1111/jocd.14806.

This article originally appeared on Dermatology Advisor