1306 When Itch Meets Apnea: Continuous Positive Airway Pressure Therapy Relieves Chronic Pruritus in Sickle Cell Disease

Abstract Introduction Sickle cell disease (SCD) is a multisystem condition caused by a genetic mutation resulting in a wide range of clinical manifestations. Dermatologically, sickle cell disease has been associated with chronic pruritus, which can be particularly distressing and difficult to manage. This case highlights an unexpected therapeutic effect of continuous positive airway pressure (CPAP) therapy in alleviating long-standing pruritus in a patient with sickle cell disease. Report of case(s) The patient is a 40-year-old male with a history of SCD who presented to the sleep clinic for evaluation of newly diagnosed severe obstructive sleep apnea (OSA). Sleep history was unremarkable aside from reported snoring. A home sleep study was obtained at the request of his pulmonologist, who sought to investigate potential contributors to his pulmonary hypertension. His apnea–hypopnea index was 53/hr, with oxygen saturation below 90% for 484 minutes. An in-lab titration study showed complete resolution of sleep disordered breathing with CPAP at 12 cmH₂O via nasal pillows, without supplemental oxygen, and he was started on these settings at home. At follow-up, he reported that the most notable improvement from CPAP was not sleep quality or alertness but complete resolution of chronic pruritus. He described persistent, distressing itching for many years with multiple topical treatments having failed to provide relief. After just one night of CPAP use, he noted a significant reduction in pruritus, which was fully resolved within one week. This unexpected improvement became his primary motivation for strict adherence to therapy. Conclusion Resolution of pruritus with CPAP therapy is not well established in medical literature. Several theories suggest that improved tissue oxygenation, reduced sleep fragmentation, and decreased sympathetic tone may contribute to skin improvement. Furthermore, randomized controlled trials and meta-analyses have demonstrated that CPAP therapy can reduce inflammatory markers such as IL-6, TNF-α, and IL-8—some of which may play a role in pruritus. This case underscores the potential secondary benefits of CPAP therapy and highlights the importance of evaluating patients with sickle cell disease for undiagnosed sleep apnea, as early recognition of this relationship may meaningfully enhance patient outcomes. Support (if any)