S0790 Correlations of Pain, Sleep, and Physical Activity in Hospitalized Subjects With Inflammatory Bowel Disease

Abstract

INTRODUCTION: Patients with inflammatory bowel disease (IBD) are often treated for pain with opioids when hospitalized. Pain may interfere with sleep and activity, but these associations are poorly understood in patients with IBD. We developed a proactive pain regimen for hospitalized adults with IBD and compared it to usual (reactive) care in a randomized, controlled trial. Within this trial, we analyzed sleep and physical activity as correlates of pain and opioid use. METHODS: Hospitalized patients with IBD enrolled in a randomized, controlled trial of proactive vs reactive pain control were provided a wearable sleep/activity tracker (Fitbit®). Daily time spent sleeping, steps taken, the number of times a person slept, and sleep quality (deep, light, and rapid eye movement REM) were compared against daily average pain scores and daily morphine milligram equivalents (MME) by Pearson’s correlation. A mixed model regression was performed to compare steps taken and time slept between the two pain control groups. We performed a subgroup analysis for subjects admitted for IBD flare using Wilcoxon Rank Sum Test. RESULTS: Thirty-three subjects enrolled in the trial; 1 withdrew consent and was excluded from analysis. 17 were randomized to the proactive arm and 15 to the reactive (control) group. Fifteen subjects in the proactive arm and 11 subjects in the reactive arm had sleep/activity data available for analysis. Baseline characteristics were similar between the two groups (Table 1). Overall, pain was not associated with sleep or step count, but increased daily MME was associated with a shorter time spent in deep sleep (r = -0.27, P = 0.046) (Table 2). There was no difference in the number of steps taken (1607 ± 536 vs 1022 ± 352 steps P = 0.18) and no difference in time spent sleeping (345 ± 99 vs 348 ± 148 minutes, P = 0.63) between the proactive and reactive groups, respectively (Figure 1). A subgroup analysis of subjects in IBD flare showed that subjects on the proactive arm took more daily steps averaged throughout the hospitalization (2231 ± 1567 vs 1056 ± 671, P = 0.03). CONCLUSION: There were no differences in sleep quantity or step counts among subjects receiving proactive vs reactive pain control. However, use of opiates for pain control was associated with less time spent in deep sleep. Larger studies are needed to clarify the impact of pain control and opiates on sleep and activity in hospitalized patients with IBD.Table 1.: Baseline characteristics of subjects enrolled. No significant difference was seen. CRP = C-reactive proteinTable 2.: Pearson Correlation between average daily pain and daily MME vs steps and stages of sleep. A higher daily MME is correlated with a reduction in time spent in deep sleep. †n = 74, *n = 98, and **n = 54; person-days data was used for analysis. MME = morphine milligram equivalentsFigure 1.: A) depicts minutes slept and B) depicts steps taken by each subject on their respective hospitalization days. There was no statistically significant difference between the two groups.