Quality of Sleep and Coexistent Psychopathology Have Significant Impact on Fatigue Burden in Patients With Inflammatory Bowel Disease

Hashash, Jana G.; Ramos-Rivers, Claudia; Youk, Ada O.; Chiu, Wai Kan; Duff, Kyle; Regueiro, Miguel; Binion, David G.; Koutroubakis, Ioannis Ε.; Vachon, A; Benhayon, David; Dunn, Michael A.; Szigethy, Eva

doi:10.1097/mcg.0000000000000729

Cited by 38 publications

(29 citation statements)

References 47 publications

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“…Fatigue is caused by a complex interaction between medication side effects, poor nutrition, depressive symptoms and inflammation, among others. Other survey-based studies have correlated sleep disturbance in IBD patients to fatigue 2,31 . A systematic approach is required to treat fatigue in patients with IBD, which has a sizeable chance of improving QOL for our IBD patients.…”

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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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 plays an important role in patients with IBD. 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).…”

Section: Introductionmentioning

confidence: 85%

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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“…In a cross‐sectional study of 131 patients with IBD, elevated CRP, also using a standard‐sensitivity assay, was associated with 3·16 greater adjusted odds of poor sleep, although numbers were small . In a recent cross‐sectional study of 631 adults with IBD, the presence of significant fatigue was associated with marginally elevated CRP and ESR in UC patients but not CD . However, these results are limited by nearly 40% missing data on inflammation and the standard‐sensitivity CRP assay used.…”

Section: Depressive Symptoms or Somatic Symptoms?mentioning

confidence: 98%

Depressive symptoms in inflammatory bowel disease: an extraintestinal manifestation of inflammation?

Moulton

Pavlidis

Norton

et al. 2019

Clinical and Experimental Immunology

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Summary Depressive symptoms are reported by more than 20% of people with inflammatory bowel disease (IBD), while sleep difficulties and fatigue are even more common. Co‐morbid depressive symptoms predict a poor IBD course, including increased risk of relapse and surgery, which is inconsistently improved by psychological treatments. Rather than being distinct systems, there is compelling evidence for bidirectional communication between gut and brain, driven by neural, metabolic, endocrine and inflammatory mediators. An emerging concept is that depressive symptoms may be mechanistically linked to excess inflammation and dysregulation of the gut–brain axis. Given the close link between the intestinal microbiota and host immune responses, patients prone to shifts in their intestinal microbiome, including smokers, those with poor diet and early life stress, may be exposed to exaggerated immune responses. Excess inflammation is associated with brain changes (depressive symptoms, fatigue, sleep difficulties) and worsening gastrointestinal symptoms, which are exacerbated by psychological distress. Equally, treatments both for depressive symptoms and IBD provide opportunities to break this cycle by reducing the causes and effects of inflammation. As well as addressing potential risk factors such as smoking and diet, treatments to alter the microbiome may reduce depressive symptoms. Observational evidence suggests that anti‐inflammatory treatments for IBD may improve co‐morbid depressive symptoms correlating with reduction in inflammation. With a growing range of treatments targeting inflammation centrally, peripherally and in the gut, IBD provides a unique model to understand the interplay between brain and gut in the pathogenesis of depressive symptoms, both in IBD and in the whole population.

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Quality of Sleep and Coexistent Psychopathology Have Significant Impact on Fatigue Burden in Patients With Inflammatory Bowel Disease

Abstract: Because fatigue is common in IBD patients, these findings suggest that attention to quality of sleep and psychopathology is as important as medical disease management.

Cited by 38 publications

References 47 publications

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

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

Depressive symptoms in inflammatory bowel disease: an extraintestinal manifestation of inflammation?

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