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

Abstract

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...

Determinants of Sleep Quality in Inflammatory Bowel Diseases

“…Iskandar et al did not notice the difference in ESS between CD and HC, but patients with active disease had higher scores than in the remission. There were also no differences in the results of actigraphy and urine melatonin levels between CD and controls [27]. In another study, there were no differences in ESS depending on the severity of the disease, while actigraphy has shown decreased sleep efficiency in moderate and severe CD group compared to patients in remission [34].…”

“…The problem of disordered sleep in immune diseases has been recently widely studied [14,16,27,28]. To date, only a few studies have been published assessing sleep quality among IBD patients using mainly PSQI [14,29].…”

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

“…An improvement in sleep and mood quality was observed in patients responding to anti-TNF-α or vedolizumab 102 . Conversely, the association between IBD and sleep disorders has been questioned by a study objectively measuring sleep parameters by actigraphy, urine melatonin metabolites and two different sleep quality indexes 103 . These data are in line with other reports suggesting the importance of IBS-like symptoms on the sleep quality of IBD patients in clinical remission 104 .…”

The relation between sleep quality, sleep quantity, and gastrointestinal problems among colorectal cancer survivors: result from the PROFILES registry

“…2 and 3). [7,[20][21][22][23]. A cross-sectional study among the general population (n = 3228) showed that those with poor sleep quality were more likely to experience gastrointestinal symptoms [20].…”