Year 2021 / Volume 113 / Number 7
Original
Prevalence and factors associated with poor sleep quality in inflammatory bowel disease outpatients

512-518

DOI: 10.17235/reed.2020.7202/2020

Elisa García Calvo, Miguel Durà Gil, Benito Velayos Jiménez, Luis I Fernández Salazar,

Abstract
Introduction: sleep disorders are common in the general population and have obvious repercussions on quality of life. Poor sleep quality is associated to inflammatory activity and fatigue in inflammatory bowel disease (IBD) patients. This study aimed to analyze the prevalence of poor sleep quality and the factors associated with it, in IBD outpatients. Methods: an observational and prospective study was performed in which epidemiological, clinical and laboratory data were collected from clinical records and patients who consecutively attended an outpatient clinic. Pittsburgh Sleep Quality index (PSQI), Hospital Anxiety and Depression Scale (HADS) and International Physical Activity Questionnaire (IPAQ) were used to measure sleep quality, anxiety, depression and physical activity, respectively. Treatment optimizations, hospital admissions or surgery were prospectively verified three months after the baseline visit. Results: one hundred and two patients were included and 54.9 % had poor sleep quality (PSQI score > 5). No association was found between poor sleep quality and IBD-related variables such as type of disease, ulcerative colitis (UC) extent, Crohn’s disease (CD) location or behavior, time from diagnosis, treatment, prior admissions or surgery and laboratory values. Rotating night shift job (OR 6.116, 95 % CI: 1.312-28.514), HAD score for depression (OR 1.125, 95 % CI: 1.062-1.490) and frequency (days per week) of vigorous physical activity (OR 0.783, 95 % CI: 0.619-0.991) were independent predictors of poor sleep quality. A Pittsburgh questionnaire score higher than 5 was not significantly associated to treatment optimization in the total patient cohort (15.2 % vs 18.2 %, p = 0.451), in UC patients (18.2 % vs 10.7 %, p = 0.362) or CD patients (12.5 % vs 25.9 %, p = 0.198). Conclusions: poor sleep quality is present in more than half of IBD patients. Aspects not directly related to IBD are associated to poor sleep quality.
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References
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DOI: 10.1097/MIB.0b013e3182a0ea54
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DOI: 10.1007/s10620-015-3580-5
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DOI: 10.1016/j.bbi.2007.04.003
1. Chavarria C, Casanova MJ, Chaparro M, et al. Prevalence and Factors Associated With Fatigue in Patients With Inflammatory Bowel Disease: A Multicentre Study. Journal of Crohn's & colitis. 2019;13(8):996-1002.
DOI: 10.1093/ecco-jcc/jjz024
2. Sofia MA, Lipowska AM, Zmeter N, et al. Poor Sleep Quality in Crohn's Disease Is Associated With Disease Activity and Risk for Hospitalization or Surgery. Inflammatory bowel diseases. 2019.
DOI: 10.1093/ibd/izz258
3. Iglesias-Rey M, Barreiro-de Acosta M, Caamano-Isorna F, et al. Psychological factors are associated with changes in the health-related quality of life in inflammatory bowel disease. Inflammatory bowel diseases. 2014;20(1):92-102.
4. Graff LA, Vincent N, Walker JR, et al. A population-based study of fatigue and sleep difficulties in inflammatory bowel disease. Inflammatory bowel diseases. 2011;17(9):1882-9.
DOI: 10.1002/ibd.21580
5. Sobolewska-Wlodarczyk A, Wlodarczyk M, Banasik J, et al. Sleep disturbance and disease activity in adult patients with inflammatory bowel diseases. Journal of physiology and pharmacology : an official journal of the Polish Physiological Society. 2018;69(3).
6. Ali T, Madhoun MF, Orr WC, et al. Assessment of the relationship between quality of sleep and disease activity in inflammatory bowel disease patients. Inflammatory bowel diseases. 2013;19(11):2440-3.
DOI: 10.1097/MIB.0b013e3182a0ea54
7. Ananthakrishnan AN, Long MD, Martin CF, et al. Sleep disturbance and risk of active disease in patients with Crohn's disease and ulcerative colitis. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2013;11(8):965-71.
DOI: 10.1016/j.cgh.2013.01.021
8. Uemura R, Fujiwara Y, Iwakura N, et al. Sleep disturbances in Japanese patients with inflammatory bowel disease and their impact on disease flare. SpringerPlus. 2016;5(1):1792.
DOI: 10.1186/s40064-016-3408-6
9. Eckert KG, Abbasi-Neureither I, Koppel M, et al. Structured physical activity interventions as a complementary therapy for patients with inflammatory bowel disease - a scoping review and practical implications. BMC gastroenterology. 2019;19(1):115.
DOI: 10.1186/s12876-019-1034-9
10. Taylor K, Scruggs PW, Balemba OB, et al. Associations between physical activity, resilience, and quality of life in people with inflammatory bowel disease. European journal of applied physiology. 2018;118(4):829-36.
DOI: 10.1007/s00421-018-3817-z
11. Echarri Piudo A. Inflammatory bowel disease - Newer models of care. Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva. 2019;111(8):577-8.
DOI: 10.17235/reed.2019.6495/2019
12. Buysse DJ, Reynolds CF, 3rd, Monk TH, et al. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry research. 1989;28(2):193-213.
DOI: 10.1016/0165-1781(89)90047-4
13. Herrero MJ, Blanch J, Peri JM, et al. A validation study of the hospital anxiety and depression scale (HADS) in a Spanish population. General hospital psychiatry. 2003;25(4):277-83.
DOI: 10.1016/S0163-8343(03)00043-4
14. Rodriguez-Munoz S, Corella C, Abarca-Sos A, et al. Validation of three short physical activity questionnaires with accelerometers among university students in Spain. The Journal of sports medicine and physical fitness. 2017;57(12):1660-8.
15. Marinelli C, Savarino EV, Marsilio I, et al. Sleep disturbance in Inflammatory Bowel Disease: prevalence and risk factors - A cross-sectional study. Scientific reports. 2020;10(1):507.
DOI: 10.1038/s41598-020-57460-6
16. Madrid-Valero JJ, Martínez-Selva JM, Ribeiro do Couto B, et al. Age and gender effects on the prevalence of poor sleep quality in the adult population. Gaceta sanitaria. 2017;31(1):18-22.
DOI: 10.1016/j.gaceta.2016.05.013
17. Wilson RG, Stevens BW, Guo AY, et al. High C-Reactive Protein Is Associated with Poor Sleep Quality Independent of Nocturnal Symptoms in Patients with Inflammatory Bowel Disease. Digestive diseases and sciences. 2015;60(7):2136-43.
DOI: 10.1007/s10620-015-3580-5
18. Frey DJ, Fleshner M, Wright KP, Jr. The effects of 40 hours of total sleep deprivation on inflammatory markers in healthy young adults. Brain, behavior, and immunity. 2007;21(8):1050-7.
DOI: 10.1016/j.bbi.2007.04.003
19. Barreiro-de Acosta M, Marín-Jiménez I, Panadero A, et al. Recommendations of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) and the Association of Crohn's Disease and Ulcerative Colitis Patients (ACCU) in the management of psychological problems in Inflammatory Bowel Disease patients. Gastroenterologia y hepatologia. 2018;41(2):118-27.
DOI: 10.1016/j.gastrohep.2017.10.003
1. Chavarria C, Casanova MJ, Chaparro M, Barreiro-de Acosta M, Ezquiaga E, Bujanda L, et al. Prevalence and Factors Associated With Fatigue in Patients With Inflammatory Bowel Disease: A Multicentre Study. Journal of Crohn's & colitis. 2019;13(8):996-1002.
DOI: 10.1093/ecco-jcc/jjz024
2. Sofia MA, Lipowska AM, Zmeter N, Perez E, Kavitt R, Rubin DT. Poor Sleep Quality in Crohn's Disease Is Associated With Disease Activity and Risk for Hospitalization or Surgery. Inflammatory bowel diseases. 2019.
DOI: 10.1093/ibd/izz258
3. Iglesias-Rey M, Barreiro-de Acosta M, Caamano-Isorna F, Rodriguez IV, Ferreiro R, Lindkvist B, et al. Psychological factors are associated with changes in the health-related quality of life in inflammatory bowel disease. Inflammatory bowel diseases. 2014;20(1):92-102.
4. Graff LA, Vincent N, Walker JR, Clara I, Carr R, Ediger J, et al. A population-based study of fatigue and sleep difficulties in inflammatory bowel disease. Inflammatory bowel diseases. 2011;17(9):1882-9.
DOI: 10.1002/ibd.21580
5. Sobolewska-Wlodarczyk A, Wlodarczyk M, Banasik J, Gasiorowska A, Wisniewska-Jarosinska M, Fichna J. Sleep disturbance and disease activity in adult patients with inflammatory bowel diseases. Journal of physiology and pharmacology : an official journal of the Polish Physiological Society. 2018;69(3).
6. Ali T, Madhoun MF, Orr WC, Rubin DT. Assessment of the relationship between quality of sleep and disease activity in inflammatory bowel disease patients. Inflammatory bowel diseases. 2013;19(11):2440-3.
DOI: 10.1097/MIB.0b013e3182a0ea54
7. Ananthakrishnan AN, Long MD, Martin CF, Sandler RS, Kappelman MD. Sleep disturbance and risk of active disease in patients with Crohn's disease and ulcerative colitis. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2013;11(8):965-71.
DOI: 10.1016/j.cgh.2013.01.021
8. Uemura R, Fujiwara Y, Iwakura N, Shiba M, Watanabe K, Kamata N, et al. Sleep disturbances in Japanese patients with inflammatory bowel disease and their impact on disease flare. SpringerPlus. 2016;5(1):1792.
DOI: 10.1186/s40064-016-3408-6
9. Eckert KG, Abbasi-Neureither I, Koppel M, Huber G. Structured physical activity interventions as a complementary therapy for patients with inflammatory bowel disease - a scoping review and practical implications. BMC gastroenterology. 2019;19(1):115.
DOI: 10.1186/s12876-019-1034-9
10. Taylor K, Scruggs PW, Balemba OB, Wiest MM, Vella CA. Associations between physical activity, resilience, and quality of life in people with inflammatory bowel disease. European journal of applied physiology. 2018;118(4):829-36.
DOI: 10.1007/s00421-018-3817-z
11. Echarri Piudo A. Inflammatory bowel disease - Newer models of care. Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva. 2019;111(8):577-8.
DOI: 10.17235/reed.2019.6495/2019
12. Buysse DJ, Reynolds CF, 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry research. 1989;28(2):193-213.
DOI: 10.1016/0165-1781(89)90047-4
13. Herrero MJ, Blanch J, Peri JM, De Pablo J, Pintor L, Bulbena A. A validation study of the hospital anxiety and depression scale (HADS) in a Spanish population. General hospital psychiatry. 2003;25(4):277-83.
DOI: 10.1016/S0163-8343(03)00043-4
14. Rodriguez-Munoz S, Corella C, Abarca-Sos A, Zaragoza J. Validation of three short physical activity questionnaires with accelerometers among university students in Spain. The Journal of sports medicine and physical fitness. 2017;57(12):1660-8.
15. Marinelli C, Savarino EV, Marsilio I, Lorenzon G, Gavaruzzi T, D'Inca R, et al. Sleep disturbance in Inflammatory Bowel Disease: prevalence and risk factors - A cross-sectional study. Scientific reports. 2020;10(1):507.
DOI: 10.1038/s41598-020-57460-6
16. Madrid-Valero JJ, Martínez-Selva JM, Ribeiro do Couto B, Sánchez-Romera JF, Ordoñana JR. Age and gender effects on the prevalence of poor sleep quality in the adult population. Gaceta sanitaria. 2017;31(1):18-22.
DOI: 10.1016/j.gaceta.2016.05.013
17. Wilson RG, Stevens BW, Guo AY, Russell CN, Thornton A, Cohen MA, et al. High C-Reactive Protein Is Associated with Poor Sleep Quality Independent of Nocturnal Symptoms in Patients with Inflammatory Bowel Disease. Digestive diseases and sciences. 2015;60(7):2136-43.
DOI: 10.1007/s10620-015-3580-5
18. Frey DJ, Fleshner M, Wright KP, Jr. The effects of 40 hours of total sleep deprivation on inflammatory markers in healthy young adults. Brain, behavior, and immunity. 2007;21(8):1050-7.
DOI: 10.1016/j.bbi.2007.04.003
19. Barreiro-de Acosta M, Marín-Jiménez I, Panadero A, Guardiola J, Cañas M, Gobbo Montoya M, et al. Recommendations of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) and the Association of Crohn's Disease and Ulcerative Colitis Patients (ACCU) in the management of psychological problems in Inflammatory Bowel Disease patients. Gastroenterologia y hepatologia. 2018;41(2):118-27.
DOI: 10.1016/j.gastrohep.2017.10.003
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Autoimmune sequential overlap syndrome (autoimmune hepatitis/primary sclerosing cholangitis) and inflammatory bowel disease: three clinical cases

DOI: 10.17235/reed.2020.6938/2020

Letter

Retrograde enteroclysis by double balloon enteroscopy in a patient with blunt abdominal trauma: small bowel stricture, intraluminal vascular lesion and Crohn’s disease

DOI: 10.17235/reed.2020.6891/2020

Original

Treatment of abdominal fistulas in Crohn’s disease and monitoring with abdominal ultrasonography

DOI: 10.17235/reed.2020.6884/2020

Original

Is endoscopic treatment of small bowel strictures effective and safe in patients with Crohn’s disease?

DOI: 10.17235/reed.2020.6852/2019

Original

Meta-analysis of protein intake on the effect of Crohn’s disease and ulcerative colitis

DOI: 10.17235/reed.2020.6851/2019

Original

Comparison of original and biosimilar infliximab (CTP-13) in biologic-naïve patients with Crohn’s disease and ulcerative colitis: a retrospective, multicenter real-life study in Spain

DOI: 10.17235/reed.2020.6847/2019

Original

Index of the Mayo Endoscopy and Ulcerative Colitis Endoscopy Index of Severity: are they equally valid?

DOI: 10.17235/reed.2020.6832/2019

Letter

Vedolizumab-associated psoriasis: until where does gut selectivity go?

DOI: 10.17235/reed.2020.6817/2019

Original

Is the degree of i2a recurrence in Crohn’s disease secondary to ischemic phenomena?

DOI: 10.17235/reed.2020.6790/2019

Original

Predictive factors of clinical response to treatment with anti-TNF agents in ulcerative colitis: what have we learned from our patients?

DOI: 10.17235/reed.2020.6688/2019

Original

Association between autoimmune pancreatitis and ulcerative colitis: a report of 12 patients

DOI: 10.17235/reed.2020.6677/2019

Letter

Intra-abdominal desmoid tumor and chronic inflammatory bowel disease. An uncommon scenario

DOI: 10.17235/reed.2020.6648/2019

Letter

Crohn’s disease in patients treated with etanercept

DOI: 10.17235/reed.2019.6554/2019

Original

Diet as an environmental trigger in inflammatory bowel disease: a retrospective comparative study in two European cohorts

DOI: 10.17235/reed.2020.6552/2019

Original

Lewis score: a useful tool for diagnosis and prognosis in Crohn’s disease

DOI: 10.17235/reed.2020.6434/2019

Review

Vedolizumab for treatment of chronic refractory pouchitis: a systematic review with pool analysis

DOI: 10.17235/reed.2019.6336/2019

Original

Development and validation of the QUECOMIICAT questionnaire: a tool to assess disease-related knowledge in patients with inflammatory bowel disease

DOI: 10.17235/reed.2019.6298/2019

Case Report

Regression of a giant pseudopolyp in a patient with colonic Crohn’s disease after therapy with infliximab

DOI: 10.17235/reed.2019.6252/2019

Original

Differences in the need for adalimumab dose optimization between Crohn’s disease and ulcerative colitis

DOI: 10.17235/reed.2019.6148/2018

Letter

A rare lymphoproliferative disorder associated with immunomodulating therapy in Crohn’s disease

DOI: 10.17235/reed.2019.5990/2018

Case Report

Leukocytoclastic vasculitis after vaccination in a patient with inflammatory bowel disease

DOI: 10.17235/reed.2019.5963/2018

Letter

The onset of ulcerative colitis during treatment with secukinumab: can anti-IL-17A be a trigger for inflammatory bowel disease?

DOI: 10.17235/reed.2019.5841/2018

Letter

Intravenous ustekinumab reinduction as a Crohn’s disease rescue strategy following a secondary non-response

DOI: 10.17235/reed.2019.5802/2018

Letter

Crohn’s disease and cystic fibrosis: there is still a lot to learn

DOI: 10.17235/reed.2018.5725/2018

Original

Vitamin D deficiency in outpatients with inflammatory bowel disease: prevalence and association with clinical-biological activity

DOI: 10.17235/reed.2018.5714/2018

Original

Apparent diffusion coefficient and enhancement patterns in MR imaging as markers of severe or moderate ileum inflammation in Crohn’s disease

DOI: 10.17235/reed.2018.5691/2018

Letter

Sweet syndrome after treatment with vedolizumab in a patient with Crohn’s disease

DOI: 10.17235/reed.2018.5603/2018

Original

The association between de novo inflammatory bowel disease and celiac disease

DOI: 10.17235/reed.2019.5535/2018

Original

Bile acid malabsorption in patients with chronic diarrhea and Crohn’s disease

DOI: 10.17235/reed.2018.5376/2017

Original

Switching from reference infliximab to CT-P13 in patients with inflammatory bowel disease: results of a multicenter study after 12 months

DOI: 10.17235/reed.2018.5368/2017

Original

Using the internet to evaluate the opinion of patients with inflammatory bowel disease with regard to the available information

DOI: 10.17235/reed.2018.5331/2017

Review

Intestinal tuberculosis and Crohn’s disease: the importance and difficulty of a differential diagnosis

DOI: 10.17235/reed.2018.5184/2017

Original

Can we rely on inflammatory biomarkers for the diagnosis and monitoring Crohn’s disease activity?

DOI: 10.17235/reed.2017.5126/2017

Original

Enteral nutrition is associated with a decreased risk of surgical intervention in Crohn’s disease patients with spontaneous intra-abdominal abscess

DOI: 10.17235/reed.2017.5116/2017

Original

Capsule endoscopy with PillCamSB2 versus PillCamSB3: has the improvement in technology resulted in a step forward?

DOI: 10.17235/reed.2017.5071/2017

Case Report

Serrated polyposis syndrome associated with long-standing inflammatory bowel disease

DOI: 10.17235/reed.2017.5068/2017

Case Report

Efficacy and safety of vedolizumab as a treatment option for moderate to severe refractory ulcerative colitis in two patients after liver transplant due to primary sclerosing cholangitis

DOI: 10.17235/reed.2017.5024/2017

Letter to the Editor

Fecal transplantation as a treatment for Clostridium difficile infection in patients with ulcerative colitis

DOI: 10.17235/reed.2017.4941/2017

Original

Treatment persistence during therapeutic sequences with adalimumab and infliximab in the treatment of Crohn’s disease

DOI: 10.17235/reed.2017.4931/2017

Original

Medium to long-term efficacy and safety of oral tacrolimus in moderate to severe steroid refractory ulcerative colitis

DOI: 10.17235/reed.2017.4899/2017

Original

Knowledge of disease and access to a specialist reported by Spanish patients with ulcerative colitis. UC-LIFE survey

DOI: 10.17235/reed.2017.4748/2016

Letter to the Editor

Ulcerative colitis with gastric and duodenal involvement

DOI: 10.17235/reed.2017.4685/2016

Original

What is the real-life maintenance mesalazine dose in ulcerative colitis?

DOI: 10.17235/reed.2016.4620/2016

Original

The concerns of Spanish patients with inflammatory bowel disease as measured by the RFIPC questionnaire

DOI: 10.17235/reed.2017.4621/2016

Editorial

Specialist care in the management of inflammatory bowel disease

DOI: 10.17235/reed.2016.4628/2016

Original

Mercaptopurine and inflammatory bowel disease: the other thiopurine

DOI: 10.17235/reed.2016.4546/2016

Original

Clinical status, quality of life, and work productivity in Crohn’s disease patients after one year of treatment with adalimumab

DOI: 10.17235/reed.2016.4600/2016

Original

The use of a segmental endoscopic score may improve the prediction of clinical outcomes in acute severe ulcerative colitis

DOI: 10.17235/reed.2016.4470/2016

Original

Fecal calprotectin and C-reactive protein are associated with positive findings in capsule endoscopy in suspected small bowel Crohn’s disease

DOI: 10.17235/reed.2016.4318/2016

Letter to the Editor

Adnexal localization of Crohn’s disease and recurrent massive ovary cysts

DOI: 10.17235/reed.2016.4301/2016

Original

Meta-analysis of the association between appendiceal orifice inflammation and appendectomy and ulcerative colitis

DOI: 10.17235/reed.2016.4176/2015

Digestive Diseases Image

All that glitters is not gold. A different cause for an "ulcerative colitis"

Letter to the Editor

Ulcerative colitis in a patient with common variable immunodeficiency: does the treatment differ from the routine?

DOI: 10.17235/reed.2016.4115/2015

Original

Initial experience with golimumab in clinical practice for ulcerative colitis

DOI: 10.17235/reed.2016.4068/2015

Original

Endoluminal calprotectin measurement in assessment of pouchitis and a new index of disease activity: a pilot study

DOI: 10.17235/reed.2016.4066/2015

Case Report

Mesalamine-induced myopericarditis - A case report

DOI: 10.17235/reed.2016.4016/2015

Original

Predictive factors of small bowel patency in Crohn's disease patients

DOI: 10.17235/reed.2015.3957/2015

Case Report

Metastatic Crohn’s disease in pediatrics

DOI: 10.17235/reed.2016.3948/2015

Editorial

INTENSIFICATION OF MAINTENANCE THERAPY WITH INFLIXIMAB IN ULCERATIVE COLITIS

DOI: 10.17235/reed.2015.3907/2015

Letter to the Editor

Crohn’s disease and Sweet’s syndrome: A debut together

DOI: 10.17235/reed.2015.3842/2015

Original

Impact of endoscopic monitoring in postoperative Crohn’s disease patients already receiving pharmacological prevention of recurrence

DOI: 10.17235/reed.2015.3836/2015

Original

FREQUENCY, PREDICTORS, AND CONSEQUENCES OF MAINTENANCE INFLIXIMAB THERAPY INTENSIFICATION IN ULCERATIVE COLITIS

DOI: 10.17235/reed.2015.3804/2015

Case Report

Primary liposarcoma of the sigmoid presenting as colonic intussusception - A case report

DOI: 10.17235/reed.2016.3943/2015

Case Report

Ovarian involvement in Crohn´s disease: A rare complication

DOI: 10.17235/reed.2015.3764/2015

Original

Impact of the age of diagnosis on the natural history of ulcerative colitis

DOI: 10.17235/reed.2015.3736/2015

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García Calvo E, Durà Gil M, Velayos Jiménez B, Fernández Salazar L. Prevalence and factors associated with poor sleep quality in inflammatory bowel disease outpatients. 7202/2020


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Publication history

Received: 29/04/2020

Accepted: 21/07/2020

Online First: 25/11/2020

Published: 07/07/2021

Article revision time: 78 days

Article Online First time: 210 days

Article editing time: 434 days


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