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已发表论文
睡眠特征与斑秃及其他非瘢痕性脱发之间的因果关系：一项双向孟德尔随机化分析
Authors Li Y, Wang Y, Zhang Y, Wang W, Ai H
Received 11 June 2025
Accepted for publication 25 October 2025
Published 5 November 2025 Volume 2025:18 Pages 2907—2921
DOI https://doi.org/10.2147/CCID.S546362
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Monica K. Li
Yanqi Li,1 Yuge Wang,1 Yankun Zhang,2 Wanchao Wang,1 Hongmei Ai1
1Department of Plastic Surgery, Emergency General Hospital, National Research Center for Emergency Medicine, Beijing, 100020, People’s Republic of China; 2Department of Dermatology and Medical Cosmetology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
Correspondence: Yankun Zhang, Department of Dermatology and Medical Cosmetology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China, Tel +86 15611386950, Email yankunzhang0803@163.com
Background: Previous studies have indicated an association between alopecia and sleep characteristics, but the causality is not clear. This study aimed to investigate the potential causal relationship between four sleep traits (morningness, sleep duration, insomnia, daytime napping) and four subtypes of alopecia (alopecia areata, androgenic alopecia, scarring, and other non-scarring alopecia).
Methods: A bidirectional mendelian randomization (MR) analysis based on genome-wide association studies (GWAS) data was employed to examine the causal relationship between alopecia and sleep characteristics. Sample sizes ranged from 209 to 452,633 participants for different traits. Various analytical approaches, including Inverse Variance Weighted (IVW), Weighted Median, MR-Egger and Weighted Mode were employed. Instrumental variables were selected based on conventional significance thresholds (P < 5 × 10− 8 for sleep traits) and structured criteria for alopecia. A Bonferroni correction was applied to account for multiple testing. Sensitivity analyses, including Cochran’s Q, leave-one-out, and MR pleiotropy residual sum and outlier (MR-PRESSO) methods, were subsequently conducted to affirm the robustness of the findings.
Results: IVW method suggested causal associations between genetically predicted insomnia and a higher risk of alopecia areata (OR (95% CI) = 3.88 (1.5– 10.04), P = 0.01), genetically predicted alopecia areata and morningness (OR (95% CI) = 1.0102 (1.0005– 1.0201), P = 0.04), as well as genetically predicted non-scarring alopecia and reduced sleep duration (OR (95% CI) = 0.9881 (0.9767– 0.9997), P = 0.04). However, these associations did not survive multiple testing correction. Cochran’s Q test revealed heterogeneity in the analysis between scarring alopecia and daytime nap (Q = 39.29, P = 0.01), indicating potential variability in the genetic effects across different SNPs. Based on MR-PRESSO and leave-one-out analyses, outliers were removed, revealing no evidence of horizontal pleiotropy in this study.
Conclusion: This MR study suggests potential bidirectional causal associations between alopecia and sleep characteristics. However, the findings should be interpreted cautiously due to multiple testing considerations. Future work should investigate mechanisms and generalize findings across populations.
Keywords: alopecia, insomnia, sleep, Mendelian randomization, causal relationship, GWAS, circadian rhythm, autoimmunity
1Department of Plastic Surgery, Emergency General Hospital, National Research Center for Emergency Medicine, Beijing, 100020, People’s Republic of China; 2Department of Dermatology and Medical Cosmetology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
Correspondence: Yankun Zhang, Department of Dermatology and Medical Cosmetology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China, Tel +86 15611386950, Email yankunzhang0803@163.com
Background: Previous studies have indicated an association between alopecia and sleep characteristics, but the causality is not clear. This study aimed to investigate the potential causal relationship between four sleep traits (morningness, sleep duration, insomnia, daytime napping) and four subtypes of alopecia (alopecia areata, androgenic alopecia, scarring, and other non-scarring alopecia).
Methods: A bidirectional mendelian randomization (MR) analysis based on genome-wide association studies (GWAS) data was employed to examine the causal relationship between alopecia and sleep characteristics. Sample sizes ranged from 209 to 452,633 participants for different traits. Various analytical approaches, including Inverse Variance Weighted (IVW), Weighted Median, MR-Egger and Weighted Mode were employed. Instrumental variables were selected based on conventional significance thresholds (P < 5 × 10− 8 for sleep traits) and structured criteria for alopecia. A Bonferroni correction was applied to account for multiple testing. Sensitivity analyses, including Cochran’s Q, leave-one-out, and MR pleiotropy residual sum and outlier (MR-PRESSO) methods, were subsequently conducted to affirm the robustness of the findings.
Results: IVW method suggested causal associations between genetically predicted insomnia and a higher risk of alopecia areata (OR (95% CI) = 3.88 (1.5– 10.04), P = 0.01), genetically predicted alopecia areata and morningness (OR (95% CI) = 1.0102 (1.0005– 1.0201), P = 0.04), as well as genetically predicted non-scarring alopecia and reduced sleep duration (OR (95% CI) = 0.9881 (0.9767– 0.9997), P = 0.04). However, these associations did not survive multiple testing correction. Cochran’s Q test revealed heterogeneity in the analysis between scarring alopecia and daytime nap (Q = 39.29, P = 0.01), indicating potential variability in the genetic effects across different SNPs. Based on MR-PRESSO and leave-one-out analyses, outliers were removed, revealing no evidence of horizontal pleiotropy in this study.
Conclusion: This MR study suggests potential bidirectional causal associations between alopecia and sleep characteristics. However, the findings should be interpreted cautiously due to multiple testing considerations. Future work should investigate mechanisms and generalize findings across populations.
Keywords: alopecia, insomnia, sleep, Mendelian randomization, causal relationship, GWAS, circadian rhythm, autoimmunity