Effect of Subjective and Objective Sleep Quality on Subsequent Peptic Ulcer Recurrence in Older Adults

Abstract

OBJECTIVE To examine the effect of subjective and objective sleep quality on subsequent recurrence of peptic ulcer disease (PUD) among older patients after Helicobacter pylori eradication. SETTING Eight grade A hospitals in China. PARTICIPANTS Of 1689 older Chinese with H. pylori–infected PUD recruited between January 2011 and October 2014, H. pylori were eradicated and PUD was cleared in 1538 patients by the end of 2014; 1420 of these patients were followed up for up to 36 months. MEASUREMENTS Using multiple measures at 6‐month intervals, PUD recurrence was determined with esophagogastroduodenoscopy. Subjective sleep quality was measured using the Pittsburgh Sleep Quality Index. Objective sleep quality domains were measured using an accelerometer, including sleep onset latency, sleep efficiency, total sleep time, and number of awakenings. RESULTS This study documented a 36‐month cumulative PUD recurrence of 8.3% (annual rate = 2.8%). Multivariate analyses showed that participants who reported poorer sleep quality were more likely to experience PUD recurrence during the 36‐month follow‐up period (hazard ratio [HR] = 1.895; 95% confidence interval [CI] = 1.008‐3.327). Regarding objective sleep quality domains, longer sleep onset latency (HR = 1.558; 95% CI = 1.156‐2.278) and more nighttime awakenings (HR = 1.697; 95% CI = 1.168‐2.665) increased the risk of PUD recurrence. However, a longer total sleeping time protected against PUD recurrence (HR = 0.768; 95% CI = 0.699‐0.885). CONCLUSIONS Poor sleep quality predicts a greater risk of PUD recurrence. Accurate diagnosis and effective treatments should, therefore, be provided for older adults afflicted with poor sleep, particularly for those who previously had PUD. It is equally important to include sleep assessment as an integral part while dealing with these patients.

Recommendations for Epidemiological Research in ME/CFS from the EUROMENE Epidemiology Working Group

“…Although accelerometers were originally developed to measure physical activity, new technical and engineer applications have also made possible to evaluate sleep patterns. To the best of our knowledge, accelerometers have been used to objectively measure sleep in samples from the general population (e.g., from youths to older adults) (Adelantado-Renau et al, 2019;Cadenas-Sanchez et al, 2016;Fang et al, 2019) and chronic populations (e.g., diabetes and fibromyalgia) (Rosique-Esteban et al, 2018;Segura-Jiménez et al, 2015) but not in ME/CFS yet.…”

Review: Helicobacter pylori and non‐malignant upper gastrointestinal diseases

“…Furthermore, several studies addressing the effects of PUD on quality of life were performed. Chinese authors focused on the effect of subjective and objective sleep quality on the recurrence of PUD after H pylori eradication in elderly patients and in older patients with mild cognitive impairment in reference to social involvement . They demonstrated that poor sleep quality was a predictor of increased risk for the recurrence of PUD and should be taken into account at least in elderly patients.…”

Impact of Subjective and Objective Sleep Quality on Peptic Ulcer Rebleeding in Older Adults

“…Poor sleep, as commonly experienced by older adults, has been found to affect gastrointestinal health negatively (1,10). During the deeper stages of sleep, defensive mechanisms against ulcer formation and bleeding such as gastric mucosal blood flow, gastric bicarbonate efflux, and melatonin secretion increase, whereas ulcerogenic factors, such as gastrin secretion, decrease (10,11).…”

“…P oor sleep quality and peptic ulcer disease (PUD) are two major public health issues leading to adverse health outcomes and reduced quality of life among older adults (1). Partially attributed to age-related increases in comorbid conditions, medication use, and sleep structure changes, poor sleep quality affects approximately 30.5% of the older adults worldwide (2).…”