Associations between chronotype, sleep disturbances and seasonality with fatigue and inflammatory bowel disease symptoms

Abstract

Growing number of studies suggests link between circadian rhythms and inflammatory bowel diseases (IBD) manifestation. We hypothesize that: 1) IBD are associated with increased eveningness and sleep disturbances; 2) eveningness and sleep disturbances are related to more severe IBD symptoms. In total, 129 participants were enrolled to this study, divided into three groups: 34 Crohn's disease (CD) patients, 38 ulcerative colitis (UC) patients and 57 healthy controls (HC) group. They all fulfilled a questionnaire, consisting of the Composite Scale of Morningness (CSM), Seasonal Pattern Assessment Questionnaire (SPAQ), Pittsburgh Sleep Quality Index, Inflammatory Bowel Disease Questionnaire (IBDQ) and Multidimensional Fatigue Inventory (MFI). Multiple regression models controlled for age and sex revealed that in CD group higher eveningness measured with CSM was associated with higher general fatigue, physical fatigue, mental fatigue and reduced motivation measured by MFI. Lower CSM morning affect is associated with greater general fatigue, physical fatigue and more reduced activity. Greater seasonality scores are associated with increased physical fatigue and more reduced activity and motivation. Lower sleep quality measured with PSQI is associated with higher physical fatigue and more reduced activity. Correlational analysis revealed that higher seasonality and lower sleep quality are associated with increased systemic and bowel symptoms and decreased emotional and social functions measured with IBDQ. In UC group, eveningness is associated with greater general fatigue, physical fatigue and more reduced activity. Higher CSM morning affect is associated with decreased general fatigue, physical fatigue and less reduced activity. Higher CSM circadian preference scores are associated with decreased general and physical fatigue, and less reduced activity. Increased seasonality is associated with more physical fatigue. Lower sleep quality is associated with greater general and physical fatigue. To our best knowledge this is the first study evaluating associations between chronotype and sleep disturbances with IBD symptoms. We have found that chronotype preferences, whose role in IBD has been until now overlooked, may be one of the important factors contributing to fatigue in this clinical group.

Cancer-related Fatigue in Relation to Chronotype and Sleep Quality in (Non-)Hodgkin Lymphoma Survivors

“…Previous studies on the association between chronotype and fatigue in other populations showed mixed results. One study showed that morning type individuals with irritable bowel symptoms reported less fatigue compared with evening types while this association was absent in healthy controls (Chrobak et al, 2018). Another study showed increased levels of chronic work-related fatigue in evening type student-workers compared with morning and intermediate types (Martin et al, 2012).…”

“…The reason to study the associations between chronotype and cancer-related fatigue and sleep quality and cancer-related fatigue is three-fold. First, studies in other populations showed associations between eveningness and fatigue (Soreca et al, 2009; Martin et al, 2012; Chrobak et al, 2018; Caruso et al, 2020) suggesting that this association might also be present in other populations. Second, it provides information on the potential working mechanism of morning light therapy as a treatment for fatigue after cancer (Ancoli-Israel et al, 2012; Redd et al, 2014; Johnson et al, 2017).…”

“…Some individuals are more prone to be active in the morning, so-called “larks,” and some individuals work better in the evening, so-called “owls.” Several studies showed an association between later chronotypes (the owls) and negative health outcomes like depression (Levandovski et al, 2011), bipolar disorders (Caruso et al, 2020), obesity (Soreca et al, 2009), and seasonal affective disorder (Lewy et al, 2006). It is also shown that a later chronotype is related to fatigue in individuals with irritable bowel symptoms (Chrobak et al, 2018) and students (Martin et al, 2012). However, the causal relationship between chronotype and negative health outcomes remains unclear.…”

Fatigue in Inflammatory Bowel Diseases: Etiologies and Management

“…Population-based sleep quality studies estimate that 32% of adults report poor sleep. Sleep deficiency is an even more common issue among patients with IBD with numerous authors including Graff et al suggesting rates of problematic sleep in individuals with both active and inactive IBD to be greater than 50% [5,32,84,[93][94][95][96].…”

Circadian rhythms: a regulator of gastrointestinal health and dysfunction

“…While there are data to support that IBD patients have circadian rhythm disruption, additional studies are needed. Chronotype may be an overlooked factor contributing to IBD, specifically that an evening chronotype may be associated with poorer outcomes and more aggressive disease course [18,19,126]. However, it is important to note that the relative contribution of chronotype compared to the involvement of other factors such as circadian rhythms, sleep duration or other sleep factors have not been well examined.…”