Issue 01

Clinical Question

Do patients with inflammatory bowel disease (IBD) have periods independent of nocturnal symptoms where sleep quality is poor, and may need additional support?

Editor’s Bottom Line

Clinicians need to be aware that poor sleep quality in patients with IBD can be dependent on nighttime disruptions but may also occur independent of nighttime disruptions.

Add sleep health to your discussions with your IBD patients.

Reference

Wilson RG, Stevens BW, Guo AY, et al. High C-reactive protein is associated with poor sleep quality independent of nocturnal symptoms in patients with inflammatory bowel disease. Dig Dis Sci. 2015 Jul;60(7):2136–43.
https://www.ncbi.nlm.nih.gov/pubmed/25701321

Synopsis

In this observational study, adult patients with IBD completed a survey assessing sleep quality (8-item) and mood (16-item). Patient responses were based on the prior 7 days. Information concerning clinical disease activity and inflammatory markers (C-reactive protein [CRP] and erythrocyte sedimentation rate [ESR]) were retrieved from medical records.

The 131 adult patients enrolled (Crohn’s disease, 78; ulcerative colitis, 53) had a median diagnosis age of 25 years. IBD-surgery was identified in 22% of patients while 56% had or were using anti-TNF therapy. No patients had diagnosed sleep disorders, including obstructive sleep apnea, and none were taking prescribed antidepressants or sleeping aids.

The sleep questionnaire identified 44% of the cohort as having poor sleep based upon the prior 7-day sleep pattern. Median CRP and ESR levels were 2 mg/dL and 8 mm/hr, respectively. Elevated CRP and ESR were identified in 19% and 26% of the cohort. 42% of patients with active IBD had significantly higher levels of CRP than those in remission (P=0.0013). More patients with high CRP levels had poor sleep quality compared to those with normal levels (70% vs. 39%, P=0.009). Similarly, the odds ratio (OR) of poor sleep with active disease was 3.96 (95% CI: 1.89-8.27). Poor sleep quality increased with the severity of depression (OR 1.10). Even when accounting for both nocturnal disturbances (e.g., washroom, pain) and depression, those with high CRP levels still had an OR of 4.89 (95% CI: 1.24-19.46) for poor sleep, implying that sleep quality was also independent of the presence of nighttime disruptions.

Details

Study Design: Retrospective observational study
Funding: NIH
Allocation: n/a
Setting: Single centre in Boston, MA
Level of Evidence: 2b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.