Association of sleep quality and mucosal healing in patients with inflammatory bowel disease in clinical remission

Michalopoulos, George; Vrakas, Spyridon; Makris, Konstantinos; Tzathas, Charalambos

doi:10.20524/aog.2018.0227

Cited by 15 publications

(23 citation statements)

References 28 publications

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“…This finding is in line with studies that show poorer sleep quality in women than in men [31,32]. Yet, it contradicts with a previous study, in which sleep quality was worse in female patients with UC compared to males with UC, and there was no significant gender difference between patients with CD [4]. This contradiction may be seen due to the differences in sample characteristics.…”

Section: Discussionsupporting

confidence: 58%

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The Effect of Dream Anxiety on Sleep Quality in Inflammatory Bowel Diseases

Kani

Dural

et al. 2019

Dig Dis

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Introduction: Declining sleep quality is a well-known issue in inflammatory bowel disease (IBD), but dream characteristics of patients with IBD and their role in sleep quality are unknown. In this study, we aimed to examine whether and how patients with ulcerative colitis (UC) and Crohn's disease (CD) differ on sleep quality, sleepiness level, and dream anxiety (DA) level compared to healthy controls (HC), controlling for their depressive and anxious tendencies. Methods: Patients and HCs were enrolled prospectively into the study. The Van DA Scale, Pittsburg Sleep Quality Index, Epworth Sleepiness Scale, Beck Depression Index, and State-Trait Anxiety Inventories were used to assess DA, sleep quality, sleepiness, depression, and anxiety, respectively. Results: Patients with IBD had significantly lower depression (p = 0.004), state anxiety (p = 0.0001), trait anxiety (p = 0.004), and DA (p = 0.0001) than HCs. Although no statistically significant difference in sleep quality was found (p = 0.99), daytime sleepiness was more common in HCs than in IBD patients (p = 0.0001). No statistically significant difference was seen in depression, state anxiety, trait anxiety, DA, sleep quality, and daytime sleepiness between patients with CD and those with UC. No correlation was found between disease activity indices and psychological parameters. Conclusion: In contrast to previous studies, this study found lower anxiety and depression levels in patients with IBD than in HCs. Moreover, DA score was higher in HCs. For the first time, we revealed that DA may be one of the factors leading to sleep disturbance in patients with IBD.

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Section: Discussionsupporting

confidence: 58%

“…Several chronic inflammatory and immune disorders, such as systemic lupus erythematosus and rheumatoid arthritis, can affect sleep quality [2,3]. This relationship was also seen between IBD and sleep quality [4]. Sleep disturbance may be seen in patients with IBD, but the reasons are still unclear.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Dream Anxiety on Sleep Quality in Inflammatory Bowel Diseases

Kani

Dural

et al. 2019

Dig Dis

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“…Our subjective data builds on previous data showing that sleep disturbances exist in CD patients compared to controls and this difference is more pronounced with active CD patients. A survey study utilizing PSQI has shown a correlation of poor sleep to mucosal healing in small number of patients, despite clinical remission 28 . An additional study using electroencephalography showed more features of disturbed sleep in 8 pediatric patients with active IBD compared to 14 patients with IBD in remission and 24 healthy controls 29 .…”

Section: Discussionmentioning

confidence: 99%

Self-reported sleep disturbance in Crohn’s disease is not confirmed by objective sleep measures

Iskandar

Linan

Patel

et al. 2020

Sci Rep

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Sleep disturbance and fatigue are commonly reported among patients with Crohn's disease (CD). In this prospective study, we aimed to define sleep quality in CD patients at various disease activity states and compare to healthy controls using objective and subjective measures. A prospective observational cohort study of CD patients seen at a tertiary academic inflammatory bowel diseases (IBD) clinic was compared to healthy volunteers. CD activity was assessed using the Harvey-Bradshaw Index (HBI). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) and objectively over 1-week using actigraphy (motion-based) and morning urinary melatonin metabolite. 121 subjects (CD patients N = 61; controls N = 60) completed the study. 34 had active CD (HBI > 4). Sleep disturbance was more frequently reported by CD subjects than controls (PSQI: 57% vs. 35%, p = 0.02) and in patients with active CD versus in remission state (PSQI 75.8% vs. 33.3%, p < 0.01; ESS: 45.5% vs. 19%, p = 0.03). Sleep parameters as measured by actigraphy and urine melatonin metabolite did not vary by group. Crohn's patients report significantly more disturbed sleep than controls. However, poor sleep was not confirmed by objective measures of sleep quality. Excessive daytime sleepiness in CD patients may be driven by factors beyond objectively measured poor sleep. Crohn's disease (CD) is one of the two major types of chronic inflammatory bowel disease (IBD) that together affect nearly 5 million individuals worldwide 1. Fatigue is a common symptom associated with CD, particularly in patients with active disease. While the cause of fatigue can be multifactorial, sleep quality is considered a likely contributing factor 2. Several studies link inflammatory bowel disease, and CD in particular, with sleep disturbance and daytime sleepiness as well as fatigue 2-5. The literature suggests a bidirectional dynamic to the cause-effect relationship of these disorders. Questionnaire-based studies have found that patients with active CD are more likely to have sleep disturbance than those in remission 2,5,6. Alternatively, other questionnaire based studies indicate that sleep disturbance itself may place CD patients at increased risk of disease flares 7,8. Animal studies confirm the latter by demonstrating that circadian disruption worsens colitis severity in experimental models 9. This existing literature highlights the importance of this health issue; however most studies to date are limited by small patient cohorts or lack of objective sleep quality assessments or healthy controls for comparison. To assess the relationship between CD and sleep we conducted a prospective cohort study examining both subjective and objective measures of sleep disturbance. Using these tools, we sought to determine whether CD diagnosis alone was associated with sleep disturbance and whether disease activity influenced sleep quality. Additionally, we examined a urinary metabolite of melatonin to determine if melatonin deficiency may e...

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“…Previous studies have confirmed that good sleep can help reduce fatigue, improve quality of life and alleviate gastrointestinal symptoms in patients with IBD (9,10). In IBD patients, the relationship between sleep, and mucosal activity and recurrence has been confirmed (11,12). Therefore, it is very important to know the sleep status of patients, which will help provide the basis for further sleep intervention in the future, and help patients improve the treatment effect ultimately.…”

Section: Introductionmentioning

confidence: 97%

Sleep Characteristics and Influencing Factors of Sleep Quality in Patients With Inflammatory Bowel Disease-Peripheral Arthritis

Zhang¹,

Xu³

et al. 2020

Front. Med.

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Background: Patients with inflammatory bowel disease-peripheral arthritis (IBD-PA) often accompany by sleep problems, but few studies have used polysomnography to investigate the objective sleep characteristics of IBD-PA. Methods: Patients in IBD-PA group, inflammatory bowel disease (IBD) group, healthy control (HC) group were examined by polysomnography (PSG) and the sleep characteristics were compared. PSG and Pittsburgh Sleep Quality Scale (PSQI) indices were compared between active and remission IBD-PA patients. The correlation between disease activity and sleep quality in IBD-PA patients was analyzed. The influencing factors of sleep efficiency of IBD-PA patients were analyzed. Results: The total sleep time (TST), rapid-eye-movement sleep (REM) time, slow wave sleep (S3 + S4) and sleep efficiency (SE) in the IBD-PA group were significantly less than those in the HC group and IBD group (P < 0.05), while the number and time of wake after sleep onset (WASO) and sleep latency (SL) were significantly longer than those in the HC group and IBD group (P < 0.05). To IBD-PA patients, the disease activity was negatively related to sleep quality. There was a significant difference in SE, the number of WASO, S1, S3+S4 of PSG, as well as the PSQI total score between active and remission patients. Abdominal pain, joint pain, depression, and C-reactive protein were the influencing factors of sleep efficiency. Conclusions: The sleep quality of patients with IBD was poor than the control group, and that of patients with IBD-PA was even worse. Therefore, sleep management should be included in IBD management.

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Association of sleep quality and mucosal healing in patients with inflammatory bowel disease in clinical remission

Cited by 15 publications

References 28 publications

The Effect of Dream Anxiety on Sleep Quality in Inflammatory Bowel Diseases

The Effect of Dream Anxiety on Sleep Quality in Inflammatory Bowel Diseases

Self-reported sleep disturbance in Crohn’s disease is not confirmed by objective sleep measures

Sleep Characteristics and Influencing Factors of Sleep Quality in Patients With Inflammatory Bowel Disease-Peripheral Arthritis

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