Functional Dyspepsia: A Risk Factor for Disordered Sleep

Abstract

Purpose: Functional dyspepsia (FD) is common but poorly understood. The prevalence of disordered sleep in FD patients (Pts) has not been prospectively studied. Aims: Evaluate sleep characteristics in FD Pts and compare to healthy controls (HC). Determine the relationship of disordered sleep to FD symptoms, disease severity, and mental and physical well-being. Methods: A normal EGD and Rome III criteria classified Pts as having FD, with further classification into epigastric pain syndrome (EPS) or post-prandial distress syndrome (PDS). Demographics, tobacco and alcohol use, exercise, level of activity and FD symptoms were identified. Validated questionnaires (Hospital Anxiety and Depression, SF-12, Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI)) assessed mental and physical well-being and sleep characteristics. HC did not have any GI symptoms. Results: 260 questionnaires were mailed to FD patients (response rate of 49%). Questionnaires were also completed by 50 HC (44±11 yrs, 92% female). The mean age of FD patients was 50±15 yrs (82% female), with an average duration of symptoms of 104±96 months. FD symptoms were present 4.2±2.1 days/week. 60% had EPS, while 15% had PDS. Pts rated their symptoms as mild (35%), moderate (52%) or severe (13%). The HAD score was higher in FD Pts with mild (24.6±8.7) and moderate/severe symptoms (27.4±9.4) compared to HC (9.6±7.0; P<0.001). PSQI total scores were similar in FD Pts with mild (8.3±4.2) and moderate/severe symptoms (10±4.3), but higher compared to HC (6.3±4.0, P<0.001). FD Pts with moderate/severe (3.8±1.5) symptoms had higher scores on the ISI compared to HC(2.7±1.3) and FD Pts with mild symptoms (3.0±1.5; P < 0.001). The correlation between PSQI and ISI scores in FD Pts was 0.57. Multivariate logistic regression analysis revealed that FD was a significant risk factor for disordered sleep compared to HC (OR=3.25, 95% CI 1.47-7.20). Female gender also tended to be associated with disordered sleep (OR=2.36, 95% CI .99-5.7). Age, tobacco and alcohol use were not. Routine exercise appeared to be protective against disordered sleep (OR=0.421; 95% CI .19-.92). Conclusion: Disordered sleep is significantly more common in FD Pts than HC. The ISI appears to be less specific than the PSQI at diagnosing sleep disorders. Routine exercise appears to decrease the likelihood of suffering from sleep disorders. FD Pts had higher scores for anxiety and depression than HC, and these were highest in patients with moderate/severe FD symptoms. This suggests that depression may be a contributing factor to FD symptom generation. Future clinical trials for FD should include validated measures of sleep, and improvements in FD symptoms may be mirrored by improvements in sleep.