Poor sleep quality & CD outcomes

February 11, 2020

Issue 03

Clinical Question

Does sleep quality correlate with clinical outcomes in Crohn’s disease?

Editor’s Bottom Line

The authors note that poor sleep is associated with worse outcomes among patients with Crohn’s disease, but their suggestion that this relationship is causal remains speculative. Further study of measures to improve sleep in patients with Crohn’s disease is needed.

Reference

Sofia AM, Lipowska AM, Zmeter N, et al. Poor Sleep Quality in Crohn’s Disease Is Associated with Disease Activity and Risk for Hospitalization or Surgery. Inflamm Bowel Dis. Epub ahead of print December 10, 2019; https://doi.org/10.1093/ibd/izz258

Synopsis

To determine the impact of sleep quality on outcomes in Crohn’s disease (CD), researchers at several American tertiary care centers enrolled 99 CD patients and 82 controls without inflammatory bowel disease and asked them to complete the Pittsburgh Sleep Quality Index (PSQI). They measured clinical disease activity for those with CD using the Harvey-Bradshaw index (HBI) and documented clinical outcomes—such as hospitalization and surgery—using electronic health records. Multivariate analyses controlled for a host of variables, ranging from tobacco consumption to body mass index (BMI). Participants were followed for up to one year after completing the survey and were re-evaluated for sleep quality and clinical disease activity. An HBI score 5 indicated active disease, while a PSQI score >5 indicated poorer sleep.

Data showed that CD and control subjects had similar characteristics and PSQI scores at baseline (8.3 vs. 7.8; p=N.S.) and there were a similar number of patients with a PSQI >5 in the CD and control groups (77% vs. 81%; p=N.S.). Higher PSQI scores correlated with higher HBI scores at baseline, and changes in these scales at follow-up were also correlated with each other. There was no correlation between PSQI scores and C-reactive protein (CRP) levels among a subset of subjects who underwent CRP testing, although those with a PSQI >5 were more likely to have an inflammatory disease phenotype, as defined using Montreal classification criteria. CD participants with poorer sleep reported waking up more often at night due to pain and bathroom use and they had a higher average BMI than CD patients with better sleep (27.4 vs. 23.7; P=0.03).

In a multivariate analysis, a PSQI score >8 at baseline predicted surgery or hospitalization during follow-up (Hazard Ratio: 5.37; 95% Confidence Interval, 1.39–27.54).

The authors suggest that, “Addressing sleep quality may be an opportunity to improve not only quality of life but also clinical outcomes.”

Details

Study Design: Prospective, controlled
Funding: National Institutes of Health award
Allocation: Cohort
Setting: Multi-center
Level of Evidence: 1b (Oxford Levels of Evidence)