Researchers have identified risk factors — greater disability, lower quality of life, and non-intestinal symptoms — for the poor sleep experienced by two-thirds of patients with inflammatory bowel disease (IBD).
Their study, “Sleep disturbance in Inflammatory Bowel Disease: prevalence and risk factors – A cross-sectional study,” was published in the journal Scientific Reports.
IBD can significantly affect the quality of life of patients, who experience severe fatigue and potential mood disorders, such as depression and anxiety.
Poor sleep quality has been associated with worse symptoms, lower work productivity, and more frequent relapses. As such, researchers at the University Hospital of Padua, in Italy, sought out to investigate sleep quality and its effects on a large cohort of IBD patients.
They evaluated a total of 166 IBD patients, including 87 with Crohn’s disease and 79 with ulcerative colitis, the two main forms of IBD. The patients were 44.39 years old on average, and nearly half (82 patients) were older than 45.
Among the participants, 134 patients were considered to be in remission, 45 had at least one extra-intestinal manifestation (EIM), and 32 patients were classified with active disease.
During the study, 98 patients were taking biologicals — including infliximab (sold as Remicade by Janssen Pharmaceutical, as well as other brand names), AbbVie’s Humira (adalimumab), Takeda’s Entyvio or Janssen’s Simponi (golimumab) — and 29 were receiving immunosuppressive therapy (azathioprine/AZA or methotrexate).
Sleeping problems were evaluated using the Pittsburgh Sleep quality index (PSQI), a self-reported questionnaire that evaluates 19 items related to sleep quality over one-month intervals. Scoring ranges from zero to 21, where lower scores correspond to better sleep quality.
In addition, patients were subjected to the IBD questionnaire (IBDQ), IBD disability index (IBI-DI), and the hospital anxiety and depression scale (HADS).
The PSQI results revealed that 67.5% of patients with IBD (112 out of 166) experienced poor sleep. Moreover, 87 of 134 patients in remission (64.9%) and 25 out of 32 of patients with active disease (78.1%) had poor sleep.
Patients with worse sleep quality also had poorer quality of life (62 of 112 or 55.4%), and 73 patients with poor sleep (65.2%) had a low disability score.
Factors such as the type of IBD condition, age, disease duration, current therapy, anemia, and elevated fecal calprotectin (a protein linked to IBD and present in the stool) were not associated with worse sleep quality.
On the contrary, IBDQ and IBD-DI scores, and extra-intestinal manifestations were independent predictors of poor sleep. Patients with lower IBDQ and IBD-DI scores had three to four times the risk of experiencing poor sleep, while patients with EIM had twice the risk compared to patients without these symptoms.
The HADS scores revealed that all patients with depression had sleep disturbances, which were experienced by 66.7% of those without depression. No statistical significant difference was found between patients with or without anxiety. Yet, researchers noted that HADS score for both anxiety and depression was proportional to PSQI results.
“We demonstrated that a poor quality of life in IBD patients is strongly related to poor quality of life, disability, and mood state,” the researchers wrote.
Overall, this study identifies relevant risk factors for sleep disturbance in IBD.
“In IBD management not only disease progression, but also sleep and disability should be investigated during clinical outpatients’ visits,” the researchers said.
This calls for a multidisciplinary team of “gastroenterologists and psychologists with the aim to improve sleep and quality of life in general, and to reduce disability and the restriction and limitations that sleep deprivation can induce in daily life,” they said.
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