A Systematic Review and Meta-Analysis of Inflammatory Bowel Disease Activity and Sleep Quality

Abstract

Background: Poor sleep quality has been associated with active inflammatory bowel disease (IBD) in several studies. This review examines sleep quality in people with active IBD and in those in remission, with a meta-analysis performed, considering subjective and objective sleep quality and IBD activity. Methods: Electronic databases were searched for publications from inception to December 1st 2020. Effect sizes were estimated to determine the association between sleep quality and IBD activity using a random effects model. Separate meta-analyses were performed for objective and subjective sleep and IBD activity, considering sleep quality in active and inactive IBD. Results: 19 studies were included in the qualitative review representing 4972 IBD patients. Subjective IBD activity was associated with subjective poor sleep quality with pooled odds ratio (OR) of 3.04 (95% CI 2.41-3.83). Sleep efficiency was lower in those self-reporting active IBD and, time awake post sleep onset was higher in those with active disease with acceptably heterogeneity. Objective IBD activity was associated with subjective poor sleep, with pooled OR of 6.64 95% CI (3.02 – 14.59). Insufficient data was available to consider objective IBD activity and objective sleep quality. Conclusion: IBD activity is associated with poor sleep using subjective and objective measures of sleep quality. This manifests as decreased sleep efficiency and increased number of waking episodes post sleep onset. This may be due to IBD symptoms, however emerging data suggests sleep quality remains poor in those with subclinical inflammation. The relationship between objective IBD activity and sleep requires further investigation. Funding: No funding sources were obtained for this study. Declaration of Interest: Conflicts of interest include speakers fees, and Ad Boards from : Abbott, AbbVie, Allergan, Anatara, AstraZeneca, Bayer, BMS 2020, Celegene, Celltrion, Falk, Ferring, Gilead, Hospira, Immuninc, ImmunsanT, Janssen, MSD, Nestle, Novartis, Progenity, Pfizer, Sandoz, Shire, Takeda, Vifor, RAH research Fund, The Hospital Research Fund 2020-2022, The Helmsley Trust 2020-2023