An investigation published in January 2020 in Scientific Reports confirms that sleep should be included as part of a patient evaluation. The study found that two-thirds of patients with IBD suffered from sleep disturbance, and poor quality of rest was tied to low quality of life, greater disability, and the presence of extraintestinal manifestations (EIMs), such as peripheral arthritis, oral ulcers, skin inflammation, and inflammation of the eye. Researchers noted that, in this study, sleep trouble did not appear to be associated with disease variables such as subtype, disease activity, or type of therapy taken. “We were surprised to identify sleep disturbance in patients with inactive IBD,” say Fabiana Zingone, a coauthor of the study and an assistant professor of gastroenterology at the University Hospital of Padua in Italy. “Overall, we can say that, due to its chronicity, IBD can influence not only the physical state of the patients, but also their psychological state," says Dr. Zingone. “As a consequence, we demonstrated that IBD patients suffer from bad quality of sleep even if their intestinal disease is clinically considered in remission.” RELATED: 5 Ways to Get Better Sleep With IBD
A Disease of Physical and Psychological Factors
According to another coauthor, Carla Marinelli, PhD, a researcher in the department of surgery, oncology, and gastroenterology at the University Hospital of Padua, the study highlights the necessity of a multidisciplinary approach to IBD management. “Both gastroenterological and psychological support working together is needed to reduce impact on quality of sleep and life in general,” says Dr. Marinelli. Research results were based on a small group of 166 patients with IBD who completed questionnaires regarding their disease, their sleep quality, anxiety, depression, and disability (which includes status of energy, body image, pain, interpersonal activities, and other symptoms). A total of 87 participants had Crohn’s disease and 79 had ulcerative colitis. The average patient age was 44, and only 16 had active disease during the study. While scientists discovered that sleep quality is not directly connected with an active or inactive IBD state or with the ongoing treatment, they found sleep is connected to a patient’s mood state, disability, and quality of life. They noted that sleep disturbance affected all depressed patients, but there were no differences in sleep disturbance between patients with or without anxiety. For Ashwin Ananthakrishnan, MBBS, MPH, a gastroenterologist at Massachusetts General Hospital in Boston and a spokesperson for the American Gastroenterological Association, this research contributes to multiple previous studies in diverse populations that have demonstrated poor sleep quality in patients with IBD and a link between poor sleep quality and depression. Although the researchers stress that this analysis was not designed to evaluate sleep’s impact on IBD, in a previous study, Dr. Ananthakrishnan and colleagues demonstrated that sleep quality during remission predicted future flares.
Making Sleep Part of Patient Assessments
As far as study limitations are concerned, the paper recognized that measurements of sleep disturbance were based on surveys and not objective measures, including evidence of disease as shown by endoscopy. Because this research provides a point-in-time snapshot of IBD’s impact on quality of life, disability, and quality of sleep, Zingone would like to see future studies evaluate IBD’s impact over the course of the disease evolution. Overall though, this investigation highlights the positive potential of sleep for IBD patients. “The improvement of sleep would definitely have a positive impact on the overall quality of life and mood,” says Zingone. “Psychological support from trained healthcare professionals may be helpful in achieving this and improving the patient’s ability to cope with IBD.” If you have IBD and trouble sleeping, the Crohn’s & Colitis Foundation offers these five tips:
