Do specific types of sleep disturbances represent risk factors for poorer health‐related quality of life in inflammatory bowel disease? A longitudinal cohort study

Abstract

Objectives. Poor global sleep quality is commonly reported in people with inflammatory bowel disease (IBD) and is linked to poorer health-related quality of life (HRQoL). However, understanding is currently limited by a lack of: (1) longitudinal research and (2) research investigating the impact of specific types of problems sleeping on IBD-related outcomes, particularly on HRQoL. Design. Observational longitudinal cohort study. Methods. N = 276 participants with IBD completed measures at baseline (T1) and 4 weeks later at T2. Four specific sleep disturbances associated with IBD including sleep apnoea, insomnia, restless legs, and nightmares were measured alongside depression, anxiety and stress, and HRQoL. Results. After controlling for participant demographics and clinical characteristics, T1 depression, anxiety, stress, and T1 HRQoL, more severe symptom severity of sleep apnoea (B = À0.30, p < .05) and insomnia symptoms (B = À0.23, p < .05) at T1 significantly predicted poorer HRQoL at T2. However, the experience of restless legs (B = À0.03, p > .87) and nightmares (B = À0.14, p > .11) at T1 did not predict HRQoL. Conclusion. Symptoms synonymous with sleep apnoea and insomnia might represent modifiable risk factors that provide independent contributions to HRQoL over time in those with IBD. These findings suggest that interventions designed to improve sleep apnoea and insomnia could confer benefits to HRQoL in those with IBD. However, more longitudinal research is needed to understand the contribution of sleep disturbances over the longer term, as well as more randomized controlled trials testing the effect of improving sleep on IBD-related outcomes. Statement of contribution What is already known on this subject? Poor global sleep quality is commonly reported by those with a diagnosis of inflammatory bowel disease. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Perceptions of sleep in Inflammatory Bowel Disease and the acceptability of sleep interventions in routine care: A qualitative study

“…However, meta-analysis of 29 studies conducted by van der Have et al (2014) concluded that disease symptom activity contributed to only 37% of the variance in Health Related Quality of Life (HRQoL), suggesting that there remains a need to elucidate additional, possibly modifiable determinants of quality of life in IBD above and beyond IBD symptoms alone. More recently problems sleeping have been suggested as a possible behavioural factor that could adversely affect IBD related outcomes and might represent a plausible treatment target in IBD that warrants further exploration (Salwen-Deremer et al, 2020;Scott et al, 2020b).…”

“…For example, Uemura et al (2016) reported a three-fold increase in IBD symptom flare-ups at a one year follow-up in those reporting poor global sleep quality at baseline. Furthermore, Scott et al (2020b) reported that symptoms of insomnia and sleep apnoea were significant predictors of future IBD HRQoL, while Graff et al (2013) found that poor sleep quality was predictive of changes in IBD related fatigue over time. Although experimental evidence is required, it's 65 possible that improving sleep in those with IBD might confer benefits to a range of IBD 66 outcomes (Salwen-Deremer et al, 2020;Scott et al, 2020b).…”

“…Furthermore, Scott et al (2020b) reported that symptoms of insomnia and sleep apnoea were significant predictors of future IBD HRQoL, while Graff et al (2013) found that poor sleep quality was predictive of changes in IBD related fatigue over time. Although experimental evidence is required, it's 65 possible that improving sleep in those with IBD might confer benefits to a range of IBD 66 outcomes (Salwen-Deremer et al, 2020;Scott et al, 2020b). For example, improving sleep in 67 those with chronic health problems (although not in IBD) has been shown to also improve 68 multiple areas that are particularly pertinent in IBD.…”

“…Furthermore, laboratory induced sleep deprivation has been shown to increase inflammatory action, a key feature in the pathology of IBD (Mullington et al, 2010). Consequently, there are growing calls 73 for the screening and subsequent treatment of sleep disturbances to be better integrated into 74 routine IBD care (Green et al, 2017;Kinnucan et al, 2013;Salwen-Deremer et al, 2020;Scott et al, 2020b). However, despite these growing calls and possible benefits of improved sleep in those with IBD, research exploring the role of sleep in peoples' experience of IBD and the acceptability of improving sleep in IBD as a viable clinical treatment target is scarce (Salwen-78 Deremer et al, 2020).…”

“…One of the key messages from the present research is that the majority of participants in the present study felt that their sleep was able to influence their mental health and IBD symptoms (and vice versa), suggesting that participants perceived sleep to have a more influential role, rather than simply an epiphenomenon of IBD symptoms themselves. The idea that sleep is not just a product of IBD symptoms, and can have a more influential role in the experience of IBD related outcomes is one that is growing empirical support (Scott et al, 2020b;Uemura et al, 393 2016). This is an important finding in that the present research also highlighted that participants also felt that when healthcare professionals do address sleep, it is generally only ever in relation to the physical IBD symptoms themselves.…”