Effect of Mind-body Bridging Program and Sleep Education Program on Gastrointestinal Symptoms in Gulf War Veterans

Abstract

Introduction: The association between sleep disturbances and GI symptoms remains conflicting. Some studies report the association of sleep disturbances with Irritable Bowel Syndrome (IBS) but not with dyspepsia, whereas others report the association of sleep disturbances with dyspepsia and not IBS. We analyzed the association among GI symptoms, sleep disturbances and psychological symptoms. We also analyzed the effect of complementary treatment of Mind-Body bridging (MBB) program and Sleep Education program (SED) on sleep, psychological and bowel symptoms in Gulf War (GW) Veterans with disturbed sleep. Methods: We screened GW Veterans for the possible presence of sleep disturbances that were not linked to sleep apnea or more severe sleep disorders, such narcolepsy, and not associated with unstable medical or psychiatric disorders. Veterans completed validated questionnaires, including, the Medical Outcomes Study-Sleep scale (MOS-SS), MOS health-related quality of life (QOL) Short Form for Veterans (SF-36V), Post-Traumatic Stress Disorder (PTSD) check list for Military (PCL-M) and Center for Epidemiology Studies-Depression scale (CESD), and the modified bowel symptom severity scale (BSS). These measurements were collected at pre, post, and 3 months follow-up of the intervention. Veterans were asked if their symptoms worsened, showed no change, or improved at post-intervention and 3 months follow up. The BSS questionnaire was completed by 15 Veterans who reported that GI symptoms were one of the higher priorities of their GW Illness symptoms. The BSS comprises: (i) severity of abdominal pain (0-100, none to severe), (ii) severity of bloating (1-100, none to severe), (iii) stool frequency, (iv) stool consistency (Bristol stool scale, 1-7, very hard to watery), (v) severity of diarrhea (0-100), (vi) severity of constipation (0-100), (vii) how satisfied are you with bowel habits (0-100), and (viii) how much is IBS affecting or interfering with your life (0-100). Results: A total of 160 GW Veterans with sleep disturbances were screened and n=73 (men=67 (92%) were enrolled in the study, with age range of 39-69 years (median=50 years). The sleep scores assessed by MOS-SS in these Veterans ranged from 33.9- 97.8 (mean±SD 64.2±15.0). The GI symptoms were selfreported by n=52/73 (71.2%) participants, Further breakdown of symptoms included: IBS=17 (23.3%), diarrhea 18 (24.7%), constipation 27 (37%), excessive gas 23 (31.5%), abdominal pain/cramps 27 (37%), reflux disorder or stomach ulcer n=33 (45.2%), Crohn's and colitis= 2 (2.7%), others 15 (20.5%). There was no difference in the severity of sleep disturbance scores between those with and without GI symptoms (Table 1). Similarly, there were no differences in sleep scores between those with and without IBS (mean scores (69.5, vs. 62.2, P=0.09), From the 52 Veterans with GI symptoms, 45 were randomized to treatment (MBB n=24 and SED n=21). Overall treatment (MBB and SED) resulted in improvement in sleep, PTSD, depression and QOL. There was no difference in improvement between two treatments among these Veterans with GI symptoms, as both treatment groups showed improvements. There was no significant improvement in GI symptoms as assessed by BSS, following the interventions (post, and 3 months follow up (Table 2).Table: Table. Baseline mean scores for MOS-SS outcomes measures indicating sleep quality in GW Veterans with and without GI symptomsTable: Table. Effect of Mind Body Bridging (MBB) program and Sleep Education (SED) program on sleep and co-occurring outcome measures among Veterans with GI symptoms (Mean scores±95% CI)Conclusion: The quality of sleep was basically comparable across the two groups of Veterans with and without GI symptoms. MBB and SED improved sleep, PTSD, depression, and overall QOL, but did not improve GI symptoms in GW Veterans. The association and effect of sleep disturbances on GI symptoms needs further investigation.