Impact of Sleep Disturbances in Inflammatory Bowel Disease
Impact of Sleep Disturbances in Inflammatory Bowel Disease
Background: Normal sleep is paramount for a healthy lifestyle and high quality of life. Sleep modulates the immune system and thus affects the course of several chronic inflammatory conditions. There are no reported studies that address the role of sleep disturbance in the course of inflammatory bowel disease (IBD). The aim of this study was to characterize sleep disturbance in IBD using validated measures of sleep and quality of life.
Methods: A self-administered, mail-in questionnaire package was sent to 205 subjects after a brief instruction. The questionnaire package was composed of the Pittsburgh Sleep Quality Index (PSQI), a measure of disease severity and the IBD-Quality of Life Questionnaire. A total of 119 subjects were recruited (58% response rate): 80 with inactive IBD, 24 with irritable bowel syndrome (IBS) and 15 healthy controls.
Results: The IBD subjects reported significantly prolonged sleep latency, frequent sleep fragmentation, higher rate of using sleeping pills, decreased day-time energy, increased tiredness and poor overall sleep quality compared to healthy controls. The abnormal sleep patterns in IBD subjects were similar to IBS subjects. The reported sleep quality was correlated with IBD disease severity score (r = 0.55, P = 0.02). Both IBD and IBS subjects thought that sleep and their disease status were correlated.
Conclusion: The results show that IBD patients have significant sleep disturbance even when their disease is not active. This problem might affect quality of life, gastrointestinal symptoms and coping ability, and might potentially modify disease severity or increase risk of flare-up. Regardless of the primary or secondary origin of this problem, sleep disturbance should be addressed in the clinical management of patients with IBD.
Sleep is of vital importance in maintaining health and quality of life. Chronic sleep loss is associated with higher work absenteeism and healthcare utilization and is closely linked to gastrointestinal (GI) symptoms, hypertension, autonomic nervous system dysfunction, impairment of glucose control and increased inflammation. A healthy sleep-wake cycle is critical for regulation of immune and neuroendocrine function, and sleepiness and fatigue are often the cardinal manifestations of acute inflammatory disorders. In a recent review from our center, we highlighted the importance of sleep in various chronic inflammatory conditions including asthma, systemic lupus erythematosus and rheumatoid arthritis. An abnormal sleep pattern can be an important factor in the disease course of chronic inflammatory conditions. Furthermore, abnormal sleep has been implicated in the worsening of symptoms of functional GI disorders suggesting that abnormalities in sleep could affect GI function. Therefore, it is not surprising that sleep abnormalities may be associated with inflammatory bowel disease (IBD), chronic inflammatory disorders of the gut. However, there is no prior research looking closely at the relationship between sleep and IBD.
The two most common IBDs, ulcerative colitis (UC) and Crohn's disease (CD), are chronic inflammatory conditions in which symptomatic periods (flare-ups) are interspersed with asymptomatic periods (remission). The etiology and pathogenesis of IBD are not fully understood. However, it is now believed that tissue injury in IBD may be the result of a complex interplay between genetic and environmental factors. There has been renewed interest in identifying and modifying these environmental factors to improve management of the disease. Chronic sleep disturbances could serve as one such factor, possibly through one or more of the following mechanisms. First, sleep can modify the immune system and subsequently affect the course of several chronic inflammatory conditions. Indeed, adequate sleep, which is believed to serve as both a protective and restorative function, could potentially calm the inflammatory process and thus improve outcome during a flare. Second, chronic sleep disturbances could modify coping ability of patients and therefore affect the experience of symptoms including abdominal pain and fatigue. Third, sleep disruption could negatively impact quality of life in a population that already experiences significant impairment in relationships and occupation.
In this study we sought to determine whether sleep disturbances are present in IBD and, if so, characterize the nature of this problem in these patients. We were also interested to explore whether such sleep patterns could directly or indirectly affect disease activity and quality of life.
Abstract and Introduction
Abstract
Background: Normal sleep is paramount for a healthy lifestyle and high quality of life. Sleep modulates the immune system and thus affects the course of several chronic inflammatory conditions. There are no reported studies that address the role of sleep disturbance in the course of inflammatory bowel disease (IBD). The aim of this study was to characterize sleep disturbance in IBD using validated measures of sleep and quality of life.
Methods: A self-administered, mail-in questionnaire package was sent to 205 subjects after a brief instruction. The questionnaire package was composed of the Pittsburgh Sleep Quality Index (PSQI), a measure of disease severity and the IBD-Quality of Life Questionnaire. A total of 119 subjects were recruited (58% response rate): 80 with inactive IBD, 24 with irritable bowel syndrome (IBS) and 15 healthy controls.
Results: The IBD subjects reported significantly prolonged sleep latency, frequent sleep fragmentation, higher rate of using sleeping pills, decreased day-time energy, increased tiredness and poor overall sleep quality compared to healthy controls. The abnormal sleep patterns in IBD subjects were similar to IBS subjects. The reported sleep quality was correlated with IBD disease severity score (r = 0.55, P = 0.02). Both IBD and IBS subjects thought that sleep and their disease status were correlated.
Conclusion: The results show that IBD patients have significant sleep disturbance even when their disease is not active. This problem might affect quality of life, gastrointestinal symptoms and coping ability, and might potentially modify disease severity or increase risk of flare-up. Regardless of the primary or secondary origin of this problem, sleep disturbance should be addressed in the clinical management of patients with IBD.
Introduction
Sleep is of vital importance in maintaining health and quality of life. Chronic sleep loss is associated with higher work absenteeism and healthcare utilization and is closely linked to gastrointestinal (GI) symptoms, hypertension, autonomic nervous system dysfunction, impairment of glucose control and increased inflammation. A healthy sleep-wake cycle is critical for regulation of immune and neuroendocrine function, and sleepiness and fatigue are often the cardinal manifestations of acute inflammatory disorders. In a recent review from our center, we highlighted the importance of sleep in various chronic inflammatory conditions including asthma, systemic lupus erythematosus and rheumatoid arthritis. An abnormal sleep pattern can be an important factor in the disease course of chronic inflammatory conditions. Furthermore, abnormal sleep has been implicated in the worsening of symptoms of functional GI disorders suggesting that abnormalities in sleep could affect GI function. Therefore, it is not surprising that sleep abnormalities may be associated with inflammatory bowel disease (IBD), chronic inflammatory disorders of the gut. However, there is no prior research looking closely at the relationship between sleep and IBD.
The two most common IBDs, ulcerative colitis (UC) and Crohn's disease (CD), are chronic inflammatory conditions in which symptomatic periods (flare-ups) are interspersed with asymptomatic periods (remission). The etiology and pathogenesis of IBD are not fully understood. However, it is now believed that tissue injury in IBD may be the result of a complex interplay between genetic and environmental factors. There has been renewed interest in identifying and modifying these environmental factors to improve management of the disease. Chronic sleep disturbances could serve as one such factor, possibly through one or more of the following mechanisms. First, sleep can modify the immune system and subsequently affect the course of several chronic inflammatory conditions. Indeed, adequate sleep, which is believed to serve as both a protective and restorative function, could potentially calm the inflammatory process and thus improve outcome during a flare. Second, chronic sleep disturbances could modify coping ability of patients and therefore affect the experience of symptoms including abdominal pain and fatigue. Third, sleep disruption could negatively impact quality of life in a population that already experiences significant impairment in relationships and occupation.
In this study we sought to determine whether sleep disturbances are present in IBD and, if so, characterize the nature of this problem in these patients. We were also interested to explore whether such sleep patterns could directly or indirectly affect disease activity and quality of life.
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