Objective Sleep Quality Assessment Using Wrist Actigraphy in Patients With Ulcerative Colitis

Abstract

Introduction: Patients with inflammatory bowel disease (IBD) have a higher prevalence of subjective sleep disturbances and this has been associated with subclinical inflammation and risk for active disease at 6 months. Although these associations are of interest, objective sleep assessment has not been performed in ulcerative colitis (UC) patients. Methods: This is a prospective assessment of adult UC patients in clinical remission who underwent surveillance colonoscopy and wore a wrist actigraphy watch for 7 days prior to colonoscopy. Subjective sleep quality and quality of life were assessed using the Pittsburgh sleep quality index (PSQI) and the short inflammatory bowel disease questionnaire (SIBDQ). Objective sleep parameters assessed were: sleep onset latency (SOL), total sleep time (TST), wake after sleep onset (WASO), sleep efficiency (SE). Endoscopy and pathology were reviewed for all patients. Statistical analysis included a Fischer’s exact test, Student’s t-test, and Pearson’s correlation coefficient. Results: Fourteen UC patients participated in the study, 9 (64%) were male, the mean age was 44.7 years (standard deviation [SD] 14.2 years), 9 patients (64.3%) were described as having pancolitis, and the mean duration of disease was 16.3 years (SD 11.4 years). A greater number of patients had abnormal objective vs. subjective sleep measures (8 (57.1%) vs. 4 (38.6%)). The mean total time in bed was 481 minutes (SD 72.4 minutes) and TST of 346 minutes (SD 112 minutes), with a calculated SE of 71.3% (SD 6%), SOL 28.5 minutes (SD 22.1 minutes), WASO 40.7 minutes (SD 17.4 minutes), and number of awakenings 30.8 (SD 12.8). Five (35.7%) patients had inflammation present on endoscopic assessment. Patients with inflammation were older (55 years vs. 39 years; p=0.04), had longer disease duration (25.8 years vs. 11 years; p=0.01), and had higher PSQI scores (7.2 vs. 2.9; p<0.01). There were no differences in objective sleep parameters between patients with inflammation and those without inflammation. There was a trend towards higher quality of life scores in patients without inflammation (p=0.08). There was an excellent correlation in all patients between SIBDQ scores and PSQI scores (r=-0.74), WASO (r=+0.64), and number of awakenings (r=+0.61). Conclusion: This is the first description of patients with UC using wrist actigraphy to assess sleep quality. There were no statistical differences in objective sleep measures between patients with histologic inflammation and those without inflammation. Despite all patients being in clinical remission, a large percentage had disrupted sleep. There was excellent correlation between quality of life and PSQI scores and objective sleep measures; WASO and average number of awakenings.