From the Guidelines
Sleep apnea can cause noticeable skin changes on examination, including dark circles, puffiness, plethora, and acanthosis nigricans, due to chronic hypoxia, intermittent oxygen desaturation, and systemic inflammation. Patients with sleep apnea often exhibit these skin changes as a result of poor sleep quality and the underlying pathophysiology of the disease. The chronic hypoxia associated with sleep apnea can lead to plethora (redness) of the face, particularly in the cheeks and nose area, as well as increased neck circumference and redundant tissue, which are risk factors for and potential signs of sleep apnea 1. Some patients develop acanthosis nigricans, a velvety, darkened skin discoloration typically found in skin folds, which is associated with insulin resistance that can develop secondary to sleep apnea.
Key Skin Changes
- Dark circles or puffiness under the eyes due to poor sleep quality and intermittent oxygen desaturation
- Plethora (redness) of the face, particularly in the cheeks and nose area
- Acanthosis nigricans, a velvety, darkened skin discoloration typically found in skin folds
- Increased neck circumference and redundant tissue
- Signs of venous stasis in the lower extremities due to right heart failure from untreated severe sleep apnea
These skin manifestations occur because sleep apnea causes intermittent hypoxia, sympathetic activation, and systemic inflammation, which collectively impact skin appearance and health. Recognition of these dermatologic findings during physical examination can provide important clues for the diagnosis of sleep apnea, as noted in the American College of Physicians guideline on the management of obstructive sleep apnea in adults 1.
From the Research
Skin Changes and Sleep Apnea
- Sleep apnea has been associated with various skin conditions, including psoriasis and atopic dermatitis, due to inflammatory pathways, obesity, mechanical upper airways obstruction, and hypoxia 2.
- The relationship between sleep apnea and skin disease is complex, and further research is needed to understand the mechanisms behind these associations 2.
- Chronic intermittent hypoxia, a characteristic of obstructive sleep apnea, can lead to increased expression of inflammatory stress markers and endothelial dysfunction, which may contribute to skin changes 3.
Inflammatory Markers and Skin Conditions
- Studies have shown that patients with obstructive sleep apnea have higher levels of inflammatory markers, such as tumor necrosis factor-α, interleukin-6, and interleukin-8, which can contribute to skin conditions 4.
- Continuous positive airway pressure (CPAP) therapy has been shown to decrease inflammatory markers and improve vascular function in patients with obstructive sleep apnea 4, 5.
- However, the impact of CPAP therapy on skin conditions specifically is not well understood and requires further research 2.
Oxidative Stress and Skin Changes
- Oxidative stress, which is increased in patients with obstructive sleep apnea, can contribute to skin changes and disease 6, 5.
- CPAP therapy has been shown to reduce oxidative stress markers and improve blood pressure in patients with sleep apnea-hypopnea syndrome 5.
- However, the relationship between oxidative stress and skin changes in patients with sleep apnea is not fully understood and requires further investigation 6.