Sleep Quality, Obstructive Sleep Apnea Risk, and Metabolic–Inflammatory Profiles in Hidradenitis Suppurativa: A Prospective Observational Study

Background Hidradenitis suppurativa (HS) is a chronic systemic inflammatory disorder increasingly associated with metabolic and cardiovascular comorbidities. Obstructive sleep apnea (OSA) shares overlapping inflammatory and metabolic pathways; however, whether increased OSA risk in HS reflects obesity alone or a broader inflammatory–metabolic phenotype remains unclear. We prospectively evaluated sleep quality, OSA risk, and their association with metabolic and inflammatory parameters in patients with HS. Methods In this prospective controlled study, 38 patients with clinically confirmed HS and 41 age-matched controls were enrolled. Sleep quality and OSA risk were assessed using the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and STOP-BANG questionnaire. Fasting metabolic parameters and inflammatory markers, including neutrophil-to-lymphocyte ratio (NLR), were analyzed. Multivariable logistic regression models were constructed to evaluate independent associations. Results HS patients demonstrated significantly worse sleep-related outcomes, including higher PSQI (p = 0.028) and ESS scores (p = 0.016). Excessive daytime sleepiness (ESS ≥ 10) was more frequent in HS (39.5% vs. 9.8%, p = 0.002). STOP-BANG scores were significantly higher (p = 0.013), and high OSA risk was observed in 26.3% of HS patients compared with 2.4% of controls (p = 0.009). Importantly, body mass index did not differ between groups (p = 0.729). HS patients exhibited a pro-inflammatory and atherogenic metabolic profile characterized by lower HDL (p < 0.001), higher triglycerides (p = 0.002), elevated neutrophil counts (p < 0.001), and increased NLR (p = 0.011). In multivariable analysis, lower HDL (OR 0.818, p < 0.001) and higher NLR (OR 1.381, p = 0.036) remained independently associated with HS. Conclusions HS is associated with impaired sleep parameters and markedly increased OSA risk independent of obesity. This increased vulnerability appears to be driven by a systemic inflammatory and atherogenic metabolic phenotype. Routine OSA screening should be considered in HS patients to mitigate potential cardiopulmonary risk. Clinical Trial Registration: Not applicable.