Predictors of Sleep Disturbance Amongst Adult IBD Patients

Abstract

Introduction: Sleep disturbances are common among patients with inflammatory bowel disease (IBD). Our objectives are to (1) determine the rates of sleep disturbance in our adult IBD patients using the Pittsburgh sleep quality index (PSQI), (2) assess the structure of the PSQI in this population to evaluate if certain items cluster together, and (3) evaluate predictors of sleep disturbance. Methods: This was a prospective observational study of IBD patients seen over a 3-year period in our IBD center. Demographic information, IBD phenotype, disease activity [Harvey Bradshaw index (HBI) for Crohn’s disease (CD) and ulcerative colitis activity index (UCAI) for UC], and quality of life (SIBDQ) were collected. Medication use including IBD medications, narcotics, and antidepressants was documented. Sleep quality was assessed using the PSQI and sleep disturbance was defined as a total PSQI score >5. Factor analysis was performed on the subscales of the PSQI. Multivariable linear regression was used to assess which clinical variables are most important in the prediction of poor sleep. Results: A total of 671 adult IBD patients were included: mean age 44.1 years (SD 14.2), 46.3% male, and the majority with CD (62.4%). Nineteen percent of patients were on narcotics and 31% on prednisone. The mean PSQI score was 6.8 (4.3) with 61% of subjects having a score consistent with a sleep disturbance. Mean SIBDQ score was 50.8 (12.9), mean HBI for CD patients was 4.5 (4.3) and mean UCAI for UC patients was 4.1 (4.8). Factor analysis of PSQI demonstrated a 2-factor solution. The first factor, termed “insomnia” included sleep efficiency, duration, latency, and subjective quality while the second factor termed “fatigue” consisted of daytime dysfunction and sleep disturbance (awakenings). For total PSQI score, 41.5% of the total variance was accounted for by age, quality of life and IBD activity (p=0.004) with only quality of life making a significant contribution. The “insomnia” factor showed a significant association with age and quality of life while the “fatigue” factor was significantly predicted by disease activity. Patients on narcotics had poorer sleep than those not on narcotics but steroid treatment for IBD did not significantly impact sleep disturbance. Conclusion: Sleep disturbance is a complex behavior. It is common in IBD and is associated with narcotic use, active disease, and poor quality of life. Further study is required to understand the impact of poor sleep hygiene on inflammation and response to IBD treatment. Disclosure - Eva Szigethy, MD - Research grant from Crohn and Colitis Foundation of America (CCFA) and honorarium from GI health foundation to write a review on narcotic bowel syndrome. Jana G. Hashash, MD, Claudia Rivers, MD, Ada Youk, PhD, Wai Kan Chiu, PhD, Laci Altman, Greg Thorkelson, MD, David G. Binion, MD, and Miguel D. Regueiro, MD, FACG - have no financial disclosures.