An Initial Report of Sleep Disturbance in Inactive Inflammatory Bowel Disease

Abstract

Background:There is an increased prevalence of gastrointestinal symptoms, peptic ulcer disease, and colon cancer in night-shiftworkers, whose sleep is commonly disrupted. Sleep complaints are an extrapyramidal symptom of irritable bowel syndrome (IBS). Sleep disruption may contribute to increased medical morbidity by weakening the ability of the immune system to protect against endotoxins-this pathway could be of potential importance to the pathogenesis and/or clinical course of inflammatory bowel disease (IBD), a chronic immunoinflammatory gastrointestinal disorder associated with marked reductions in quality of life. This is the first study to comprehensively examine sleep concerns in patients with IBD. Methods: Sixteen patients with biopsy-proven inactive IBD (8 with Crohn disease and 8 with ulcerative colitis), 9 patients with IBS, and 7 healthy controls completed the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Inflammatory Bowel Disease Questionnaire, SF-12, and a single overnight polysomnogram. Polysomnography and arousals were scored according to standard criteria. Multivariate analyses were used to compare subjective and objective sleep parameters between groups and to identify associations between sleep complaints and quality of life. Results: Patients with IBD did not seem to significantly differ from patients with IBS, who have established sleep complaints. On polysomnography, total sleep time differentiated the 3 groups well, with the IBS and IBD groups appearing numerically similar. Whereas IBS and IBD groups were similar with respect to observed sleep parameters, IBS patients did report the most concerns, consistent with earlier research suggesting that hyperarousal and perceptual differences may contribute to symptom reporting. Conclusion: Sleep parameters greatly influenced quality of life in both groups and highlight the need to address sleep concerns as part of IBD management.

Sleep disturbances in irritable bowel syndrome: a systematic review

“…The most common objective sleep measure among these studies (15/16) was PSG, and only two studies employed actigraphy. 22,23 Five studies used only subjective sleep measures, 8,10,[12][13][14] three studies used only PSG, [24][25][26] and the remaining 13 studies 11,15,22,23,[27][28][29][30][31][32][33][34][35] used at least one subjective and one objective sleep measure. Frequent awakening was also an important concern for patients with IBS in a study by Ranjbaran et al 14 Childhood abuse and neglect seems to influence the sleep quality in women with IBS; whereas little is known about men with IBS.…”

“…31 However, in this review inconsistent findings on the relationship of psychological factors to subjective sleep were found. For example, researchers 8,14,15,27,[30][31][32][33][34][35] reported that psychological factors (e.g., anxiety, depression, or stress) influenced the degree of subjective report differences between IBS and the con- In addition to alterations in REM sleep, there is some evidence that persons with IBS spend increased time in light sleep (Stages 1 and 2). 33 Given that arousal/awakenings occur more easily in light sleep, this alteration might explain the increased frequency of reported arousal/ awakenings in persons with IBS.…”

“…31 In addition, longer latency to REM sleep is reported in women with IBS. 15 A few researchers reported shorter sleep length among people with IBS, both in subjective sleep 14,27,32 and objective sleep. 22,32,33 However, most studies 11, 24-27, 29-31, 34 found no difference in total sleep hours between IBS and control groups.…”

“…15 A few researchers reported shorter sleep length among people with IBS, both in subjective sleep 14,27,32 and objective sleep. 22,32,33 However, most studies 11, 24-27, 29-31, 34 found no difference in total sleep hours between IBS and control groups. In regard to sleep stages, study results from PSG-measured sleep variables showed that patients with IBS had more stage 2% 33 and REM% 23, 25 than controls.…”

Cortical visual areas process intestinal information during slow‐wave sleep

“…[1][2][3][4][5] Multiple visceral disorders, including in the gastrointestinal system, also follow sleep disturbances in humans. [6][7][8][9] However, probably because of the large changes in cerebral electrical activity which accompany transition from wakefulness to sleep most basic studies of sleep have been mainly focused on various aspects of cerebral functions, as reviewed in several recent publications. [10][11][12] It is generally recognized at present that, during periods of slow-wave sleep, cortical neurons change their firing mode to a synchronized burst-pause pattern, shown by slow waves in EEG recordings.…”