Original article
Alimentary tract
Sleep Disturbance and Risk of Active Disease in Patients With Crohn's Disease and Ulcerative Colitis

https://doi.org/10.1016/j.cgh.2013.01.021Get rights and content

Background & Aims

Impairment of sleep quality is common in patients with inflammatory bowel diseases (IBDs) (eg, Crohn's disease [CD] and ulcerative colitis [UC]), even during clinical remission. Sleep impairment can activate inflammatory pathways. Few prospective studies have examined the role of sleep disturbance on risk of relapse in IBD.

Methods

We analyzed data from 3173 patients with IBD (1798 in clinical remission at baseline) participating in the Crohn's and Colitis Foundation of America Partners study, a longitudinal, Internet-based cohort. Sleep disturbance was measured using a subset of questions from the Patient Reported Outcomes Measurement Information Systems sleep disturbance questionnaire. Disease activity was assessed using the short Crohn's Disease Activity Index and the simple clinical colitis activity index for CD and UC, respectively. Logistic regression was used to identify predictors of sleep quality and examine the effect of sleep quality at baseline among patients in remission on risk of active disease at 6 months.

Results

Disease activity, depression, female sex, smoking, and use of corticosteroids or narcotics were associated with sleep disturbance at enrollment. Among 1291 patients whose CD was in remission at baseline, those with impaired sleep had a 2-fold increase in risk of active disease at 6 months (adjusted odds ratio, 2.00; 95% confidence interval, 1.45–2.76); however, no effect was observed in patients with UC (odds ratio, 1.14; 95% confidence interval, 0.75–1.74). These findings persisted in a number of sensitivity analyses.

Conclusions

Sleep disturbance was associated with an increased risk of disease flares in CD but not UC. These findings indicate that the evaluation and treatment of sleep disturbance in patients with CD might improve outcomes.

Section snippets

Study Cohort and Variables

The data source for this study was the Crohn's and Colitis Foundation of America (CCFA) Partners IBD cohort. The creation of this cohort has been described in detail in previous publications.20, 21 In brief, CCFA Partners is a longitudinal Internet-based cohort of patients with IBD. Participants with a self-reported diagnosis of UC, CD, or indeterminate colitis who were older than 18 years were invited to participate in the study through the CCFA e-mail roster, social media, and at educational

Study Cohort

A total of 4366 individuals who had both a baseline and a 6-month follow-up survey were eligible for inclusion in our study. The median interval between completion of the baseline and follow-up survey was 7 months (interquartile range, 6.5–7.8 mo). After excluding patients with a stoma or pouch (because standard symptom-based measures of disease activity are not applicable to these patients), indeterminate colitis, a change in their IBD diagnosis during the follow-up period, and those with

Discussion

Sleep impairment is common in chronic inflammatory diseases.13, 14, 15, 16, 17, 30, 31, 32, 33, 34, 35, 36, 37 Biological mechanisms support a potential role for sleep impairment in disease relapse in IBD15, 16, 17; nevertheless there are few published studies examining this hypothesis. By using a large IBD cohort, we showed that CD patients who have impaired sleep quality while in clinical remission have a greater risk of disease flare. We did not identify this effect in UC.

There has been

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    Conflicts of interest The authors disclose no conflicts.

    Funding Supported in part by a grant from the National Institutes of Health (K23 DK097142 to A.N.A.), and the Crohn's and Colitis Foundation of America Partners cohort is supported by grants from the Crohn's and Colitis Foundation of America and the National Institutes of Health (P30 DK34987).

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