Abstract
Purpose
Treatment of ulcerative colitis (UC), given its chronicity and its associated disruptive and often distressing symptoms, is increasingly focusing on maximizing patient quality of life. Poorer quality of life has been found among patients with poor sleep quality, which is much more common in patients with UC than in the general population and may be associated with inflammation and psychological distress.
Method
Forty-seven patients with UC (n = 11 flaring) completed measures of sleep quality, depression, state anxiety, gastrointestinal-related anxiety, perceived stress, and quality of life. Measures of inflammation were also obtained.
Results
Patients endorsed high rates of poor sleep quality, which was highly correlated with depression and poorer inflammatory bowel disease-related quality of life, but was generally not related to other areas of psychological functioning or inflammation. Sleep quality was significantly independently associated with depression and female gender.
Conclusion
Poor sleep quality is prevalent in patients with UC and is strongly related to depression, suggesting that sleep and mood are important areas to assess in patients with UC in order to inform tailored treatment to improve quality of life.
Similar content being viewed by others
References
Ranjbaran Z, Keefer L, Farhadi A, Stepanski E, Sedghi S, Keshavarzian A. Impact of sleep disturbances in inflammatory bowel disease. J Gastroenterol Hepatol. 2007;22(11):1748–53.
Parekh PJ, Oldfield Iv EC, Challapallisri V, Ware JC, Johnson DA. Sleep disorders and inflammatory disease activity: chicken or the egg? Am J Gastroenterol. 2015;110(4):484–8.
Ranjbaran Z, Keefer L, Stepanski E, Farhadi A, Keshavarzian A. The relevance of sleep abnormalities to chronic inflammatory conditions. Inflamm Res. 2007;56(2):51–7.
Graff LA, Vincent N, Walker JR, Clara I, Carr R, Ediger J, et al. A population-based study of fatigue and sleep difficulties in inflammatory bowel disease. Inflamm Bowel Dis. 2011;17(9):1882–9.
Zeitlhofer J, Schmeiser-Rieder A, Tribl G, Rosenberger A, Bolitschek J, Kapfhammer G, et al. Sleep and quality of life in the Austrian population. Acta Neurol Scand. 2000;102(4):249–57.
Ali T, Madhoun MF, Orr WC, Rubin DT. Assessment of the relationship between quality of sleep and disease activity in inflammatory bowel disease patients. Inflamm Bowel Dis. 2013;19(11):2440–3.
Gingold-Belfer R, Peled N, Levy S, Katz N, Niv Y, Fass R, et al. Impaired sleep quality in Crohn’s disease depends on disease activity. Dig Dis Sci. 2014;59(1):146–51.
Addolorato G, Capristo E, Stefanini GF, Gasbarrini G. Inflammatory bowel disease: a study of the association between anxiety and depression, physical morbidity, and nutritional status. Scand J Gastroenterol. 1997;32(10):1013–21.
Morys JM, Kaczówka A, Jeżewska M. Assessment of selected psychological factors in patients with inflammatory bowel disease. Prz Gastroenterol. 2016;11(1):47–53.
Bao YP, Han Y, Ma J, Wang RJ, Shi L, Wang TY, et al. Cooccurrence and bidirectional prediction of sleep disturbances and depression in older adults: meta-analysis and systematic review. Neurosci Biobehav Rev. 2017;75:257–73.
Meerlo P, Havekes R, Steiger A. Chronically restricted or disrupted sleep as a causal factor in the development of depression. Curr Top Behav Neurosci. 2015;25:459–81.
Menefee LA, Frank ED, Doghramji K, Picarello K, Park JJ, Jalali S, et al. Self-reported sleep quality and quality of life for individuals with chronic pain conditions. Clin J Pain. 2000;16(4):290–7.
Blom K, Jernelöv S, Kraepelien M, Bergdahl MO, Jungmarker K, Ankartjärn L, et al. Internet treatment addressing either insomnia or depression, for patients with both diagnoses: a randomized trial. Sleep. 2015;38(2):267–77.
Guyatt G, Mitchell A, Irvine EJ, Singer J, Williams N, Goodacre R, et al. A new measure of health status for clinical trials in inflammatory bowel disease. Gastroenterology. 1989;96(3):804–10.
Schroeder KW, Tremaine WJ, Ilstrup DM. Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. A randomized study. N Engl J Med. 1987;317(26):1625–9.
Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213.
Beck AT, Steer RA, GK B. Manual for the Beck Depression Inventory—II. San Antonio, TX: Psychological Corporation; 1996.
Whisman MA, Perez JE, Ramel W. Factor structure of the Beck Depression Inventory—second edition (BDI-II) in a student sample. J Clin Psychol. 2000;56(4):545–51.
Spielberger CD. Manual for the State-Trait Anxiety Inventory STAI. Palo Alto, CA: Consulting Psychologists Press; 1983.
Labus J, Bolus R, Chang L, et al. The Visceral Sensitivity Index: development and validation of a gastrointestinal symptom-specific anxiety scale. Aliment Pharmacol Ther. 2004;20:89–97.
Levenstein S, Prantera C, Varvo V, Scribano ML, Berto E, Luzi C, et al. Development of the Perceived Stress Questionnaire: a new tool for psychosomatic research. J Psychosom Res. 1993;37(1):19–32.
Powell-Tuck J, Day DW, Bucknell NA, et al. Correlations between defined sigmoidoscopic appearances and other measures of disease activity in ulcerative colitis. Dig Dis Sci. 1982 Jan;27:533–7.
van Hees PA, van Elteren PH, van Lier HJ, van Tongeren JH. An index of inflammatory activity in patients with Crohn’s disease. Gut. 1980;21(4):279–86.
Cohen RD. The quality of life in patients with Crohn’s disease. Aliment Pharmacol Ther. 2002;16(9):1603–9.
Jowett SL, Seal CJ, Barton JR, Welfare MR. The short inflammatory bowel disease questionnaire is reliable and responsive to clinically important change in ulcerative colitis. Am J Gastroenterol. 2001;96(10):2921–8.
Galgut BJ, Lemberg DA, Day AS, Leach ST. The value of fecal markers in predicting relapse in inflammatory bowel diseases. Front Pediatr. 2018;5:292.
Lewis JD. The utility of biomarkers in the diagnosis and therapy of inflammatory bowel disease. Gastroenterology. 2011;140(6):1817–1826.e2.
Salazar J, Martínez MS, Chávez-Castillo M, et al. C-reactive protein: an in-depth look into structure, function, and regulation. Int Sch Res Notices. 2014;2014:653045.
Vermeire S, Van Assche G, Rutgeerts P. Laboratory markers in IBD: useful, magic, or unnecessary toys? Gut. 2006;55(3):426–31.
Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. JSTOR. 1995;57(1):289–300.
Madrid-Valero JJ, Martínez-Selva JM, Ribeiro do Couto B, Sánchez-Romera JF, Ordoñana JR. Age and gender effects on the prevalence of poor sleep quality in the adult population. Gac Sanit. 2017;31(1):18–22.
Lu CL, Chang FY, Lang HC, Chen CY, Luo JC, Lee SD. Gender difference on the symptoms, health-seeking behaviour, social impact and sleep quality in irritable bowel syndrome: a Rome II-based survey in an apparent healthy adult Chinese population in Taiwan. Aliment Pharm. 2005;21(12):1497–505.
Mann S. Melatonin for ulcerative colitis? Am J Gastroenterol. 2003;98:232–3.
Goodhand JR, Greig FI, Koodun Y, McDermott A, Wahed M, Langmead L, et al. Do antidepressants influence the disease course in inflammatory bowel disease? A retrospective case-matched observational study. Inflamm Bowel Dis. 2012;18(7):1232–9.
Colombo F, Rizzi A, Ferrari C, Frontali A, Casiraghi S, Corsi F, et al. Bariatric surgery in patients with inflammatory bowel disease: an accessible path? Report of a case series and review of the literature. J Crohns Colitis. 2015;9(2):185–90.
Koren D, Dumin M, Gozal D. Role of sleep quality in the metabolic syndrome. Diabetes Metab Syndr Obes. 2016;9:281–310.
Funding
This work was supported by the National Center for Complementary and Integrative Health at the National Institutes of Health (grant number 5R01AT007143-05).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
This study was approved by the Institutional Review Board and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments. Informed consent was obtained from all individuals included in the study.
Conflict of Interest
The authors declare that there is no conflict of interest.
Rights and permissions
About this article
Cite this article
Hood, M.M., Wilson, R., Gorenz, A. et al. Sleep Quality in Ulcerative Colitis: Associations with Inflammation, Psychological Distress, and Quality of Life. Int.J. Behav. Med. 25, 517–525 (2018). https://doi.org/10.1007/s12529-018-9745-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12529-018-9745-9