Poor Sleep Quality in Crohn’s Disease Is Associated With Disease Activity and Risk for Hospitalization or Surgery

Abstract

Background and Aims Poor sleep quality in Crohn’s disease (CD) is associated with histologic activity and clinical relapse. We sought to characterize sleep dysfunction and determine the effect of poor sleep quality on risk for hospitalization and surgery. Methods Clinical data were collected for CD subjects including the Pittsburgh Sleep Quality Index (PSQI) and Harvey-Bradshaw index (HBI). The PSQI score and a brief medical history were obtained for control subjects. The PSQI and HBI correlation was tested at an initial clinic visit and at follow-up. Crohn’s disease subjects with and without poor sleep were compared for risk of hospitalization or surgery by Kaplan–Meier and Cox proportional hazards. Results Ninety-two CD and 82 control subjects were included. Crohn’s disease and control subjects shared similar baseline characteristics and PSQI (8.3 vs 7.8, P = 0.31), and 77% of the CD population had PSQI >5. Crohn’s disease subjects with PSQI >5 more often had inflammatory phenotypes and reported increased benzodiazepine and psychiatric medication use. Crohn’s disease subjects with PSQI >5 also reported more night awakenings due to pain and bathroom use. The PSQI correlated with HBI (r = 0.256, P = 0.014), and ΔPSQI on follow-up correlated with ΔHBI (r = 0.47, P = 0.002). Cox proportional hazards model for hospitalization or surgery showed that PSQI >8 was predictive of surgery or hospitalization (hazards ratio 5.37; 95% confidence interval, 1.39–27.54). Conclusion There is a high burden of poor sleep quality in CD, which is associated with risk for adverse outcomes. Sleep quality may identify CD patients at risk for complications and have prognostic value in CD.

Brain‐derived neurotrophic factor is elevated in the blood serum of Crohn's disease patients, but is not influenced by anti‐TNF‐α treatment—A pilot study

“…14 Another study found that poor sleep quality was associated with aggravated CD symptoms. 15 Differences in sleep duration between CD patients in exacerbation, remission and HC were also noted. 16 In addition, BDNF appears to be associated with inflammation.…”

“…Sonnenberg et al showed that irregular working hours and exposure to artificial light are associated with the increased occurrence of IBD 14 . Another study found that poor sleep quality was associated with aggravated CD symptoms 15 . Differences in sleep duration between CD patients in exacerbation, remission and HC were also noted 16 …”

Gut–Brain Axis: Potential Factors Involved in the Pathogenesis of Parkinson's Disease

“…Sleep disorder is one of the non-motor symptoms reported in PD patients in the prodromal phase (64,65). Interestingly, sleep disturbance has also been reported in IBD patients (66,67). The underlying mechanisms for the sleep disturbance in PD and IBD are yet to be elucidated.…”

Sleep disorders related to nutrition and digestive diseases: a neglected clinical condition

“…Inflammatory cytokines such as tumor necrosis factor-α (TNF-α), interleukin (IL) -1, and IL-6 cause sleep disturbances, while sleep deprivation upregulates cytokines [97], particularly IL-1 and TNF-α. Clinical studies identified an association between sleep disturbances, disease activity, subclinical inflammation, and risk of IBD relapse [98][99][100]. A recent trial reported that poor sleep quality, evaluated using the Pittsburgh Sleep Quality Index, was associated to the absence of mucosal healing (P<0.05) [101].…”