Published: Oct 18, 2013
By Charles Bankhead, Staff Writer, MedPage Today

Full Story:  http://www.medpagetoday.com/MeetingCoverage/ACG/42368

SAN DIEGO — Poor sleep quality had a significant association with active inflammatory bowel disease (IBD) and several potentially modifiable factors, culminating in poor health-related quality of life (HRQOL), a survey of 200 patients showed.

Patients with self-reported poor sleep quality were three times as likely to have active IBD as compared with patients who reported good sleep quality. The findings extend those of previous studies showing an association between poor sleep quality, poor HRQOL, and inactive IBD.

Poor sleep also had significant associations with smoking, use of sleep aids and narcotics, and comorbid anxiety and depression, Jami A. Kinnucan, MD, of the University of Chicago, reported here at the American College of Gastroenterology meeting.

“Our model [of HRQOL] resulted in an adjusted r² value of 0.54, meaning that 54% of the variance in the model could be explained by sleep quality and disease activity,” said Kinnucan.

Patients with IBD, active or inactive, tend to have poor sleep quality, which has been shown to predict subclinical inflammation and an increased risk of relapse. Studies of other diseases have shown that poor sleep is associated with worse HRQOL, including ovarian cancer, sleep-disordered breathing, hemodialysis, and breast cancer.

Previous studies suggested a relationship between sleep quality and HRQOL in patients with inactive IBD. Whether the association extends to patients with active IBD has remained unclear. To examine the issue, Kinnucan and colleagues surveyed patients with both stages of IBD asking about sleep quality and HRQOL.

The study involved adult patients with IBD, identified through an outpatient clinic, a procedural unit, or hospital admission. Disease status of each patient was determined from medical records.

As part of their interview, patients completed the Short Inflammatory Bowel Disease Questionnaire (SIBDQ) and the Pittsburgh Sleep Quality Index (PSQI). The SIBDQ is a 10-item survey that assesses HRQOL over a 2-week period. The questionnaire comprises four HRQOL domains: emotional, physical, social, and systemic.

The PSQI assesses sleep quality and disturbances over a 1-month period. The questionnaire assesses six aspects of sleep quality, and a total score >5 reflects poor sleep quality.

Of the 200 patients included in the study, 126 (63%) had Crohn’s disease and 74 (37%) had ulcerative colitis. They had a mean age of 41, slightly more were females (53%), and 13% were obese.

Medical records indicated that 53 patients (26.5%) had active disease and 147 (73.5%) had inactive IBD. A majority (109, 53.5%) of the patients had PSQI scores >5.

Comparison of patient characteristics associated with good and poor sleep quality showed that poor sleepers were older (42.6 versus 38.2, P=0.05), more likely to have active disease (37.6% versus 13.2%, P<0.05), smoked more (40.4% versus 15.4%, P<0.05), used sleep aids more often (49.5% versus 7.7%, P<0.05), more often required narcotics for pain relief (14.7% versus 5.5%, P<0.05), were more anxious (22% versus 7.7%, P<0.05), and were more depressed (22% versus 9.9%, P<0.05).

Patients with active disease had a mean PSQI score of 9.4 as compared with 5.8 for the inactive-IBD group (P<0.05). The group with active disease also had significantly worse scores for hours in bed, sleep efficiency, increased nighttime pain, increased daytime sleepiness, and use of sleep aids (P<0.05 for all comparisons).

Patients with active disease had significantly lower mean total SIBDQ score (37.7% versus 55.9%, P<0.05). A similar disparity was observed between poor and good sleepers (44.9% versus 58.5%, P<0.05).

By multiple regression analysis, both sleep quality and disease activity had significant associations with HRQOL (P<0.05). Other predictors of poorer HRQOL were age, narcotic use, steroid use, and anxiety (P<0.05 for all).

In response to a question from the audience, Kinnucan said the determination of active disease was based on clinical signs and symptoms because endoscopic results and tissue samples were not available for all patients. Rather than have a mix of clinical indicators, she and her colleagues chose to use consistent criteria to determine active versus inactive disease.

Stephen Hanauer, MD, also of the University of Chicago asked Kinnucan how she and her colleagues plan to “separate the chicken and the egg,” referring to the observation that both disease activity and poor sleep quality contributed to poor HRQOL.

“It’s harder to say what the chicken or the egg is because we don’t know whether they are sleeping poorly because they are getting up to go to the bathroom or is their disease activity being triggered by poor sleep, which is known to have proinflammatory effects,” said Kinnucan. “I think it’s a starting point for at least screening patients for sleep quality.”