Digestive Diseases and Sciences

, Volume 53, Issue 3, pp 694–703 | Cite as

Autonomic Nervous System Function During Sleep Among Women with Irritable Bowel Syndrome

  • Monica E. Jarrett
  • Robert L. Burr
  • Kevin C. Cain
  • James D. Rothermel
  • Carol A. Landis
  • Margaret M. Heitkemper
Original Paper


This study compared heart-rate variability (HRV) indices of autonomic nervous system function during two nights of sleep between women with irritable bowel syndrome (IBS, n = 35) and healthy controls (n = 38), and among subgroups within the IBS sample based on predominant stool patterns. HRV measures were estimated in conjunction with polysomnographic sleep scoring to define sleep stage-specific autonomic indices. Overall, there were no differences in indicators of HRV between women with IBS and controls. However, within the IBS group, women with diarrhea-predominant IBS demonstrated significantly increased parasympathetic modulation and lower sympathetic/parasympathetic nervous system balance across sequential NREM periods and REM cycles compared to both constipation-predominant and alternating IBS subjects. These results suggest that differences in mean level of HRV between predominant bowel groups in IBS patients are large, and that this effect is consistent in the different sleep stages and at different times of night.


Heart-rate variability Irritable bowel syndrome Sleep Autonomic nervous system 



We would like to thank Drs. Roseanne Armitage and Robert F. Hoffmann at the University of Michigan-Ann Arbor Sleep and Chronophysiology Laboratory for sharing their NREMPGET program to identify and to partition NREM periods during sleep. We would also like to thank the women who volunteered for this study, which involved sleeping for several nights in a strange place covered by electrodes. We appreciated Dr. Marty Lentz’s willingness to be consulted on issues large and small related to sleep. Supported by grants from the NINR, NIH (NR01094 and P30 NR04001).


  1. 1.
    Orr WC, Elsenbruch S, Harnish MJ (2000) Autonomic regulation of cardiac function during sleep in patients with irritable bowel syndrome. Am J Gastroenterol 95:2865–2871PubMedCrossRefGoogle Scholar
  2. 2.
    Robert JJ, Orr WC, Elsenbruch S (2004) Modulation of sleep quality and autonomic functioning by symptoms of depression in women with irritable bowel syndrome. Dig Dis Sci 49:1250–1258PubMedCrossRefGoogle Scholar
  3. 3.
    Thompson JJ, Elsenbruch S, Harnish MJ, Orr WC (2002) Autonomic functioning during REM sleep differentiates IBS symptom subgroups. Am J Gastroenterol 97:3147–3153PubMedCrossRefGoogle Scholar
  4. 4.
    Heitkemper M, Burr RL, Jarrett M, Hertig V, Lustyk MK, Bond EF (1998) Evidence for autonomic nervous system imbalance in women with irritable bowel syndrome. Dig Dis Sci 43:2093–2098PubMedCrossRefGoogle Scholar
  5. 5.
    Cain KC, Jarrett ME, Burr RL, Hertig VL, Heitkemper MM (2007) Heart rate variability is related to pain severity and predominant bowel pattern in women with irritable bowel syndrome. Neurogastroenterol Motil 19:110–118PubMedCrossRefGoogle Scholar
  6. 6.
    Lee K, Rhee P, Kim J, Koh K, Paik S, Rhee J, Kim J (1997) Assessment of autonomic tone over a 24-hour period in patients with irritable bowel syndrome. Gastroenterology 112:A773CrossRefGoogle Scholar
  7. 7.
    Lee C, Chuang T, Lu C, Chen C, Chang F, Lee S (1998) Abnormal vagal cholinergic function and psychological behaviors in irritable bowel syndrome patients: a hospital-based Oriental study. Dig Dis Sci 43:1794–1799PubMedCrossRefGoogle Scholar
  8. 8.
    Robert J, Elsenbruch S, Orr W (2006) Sleep-related autonomic disturbances in symptom subgroups of women with irritable bowel syndrome. Dig Dis Sci 51(12):2121–2127PubMedCrossRefGoogle Scholar
  9. 9.
    Rotenberg VS, Shami E, Barak Y, Indursky P, Kayumov L, Mark M (2002) REM sleep latency and wakefulness in the first sleep cycle as markers of major depression: a controlled study vs. schizophrenia and normal controls. Prog Neuropsychopharmacol Biol Psychiatr 26:1211–1215CrossRefGoogle Scholar
  10. 10.
    Trinder J, Kleiman J, Carrington M, Smith S, Breen S, Tan N, Kim Y (2001) Autonomic activity during human sleep as a function of time and sleep stage. J Sleep Res 10:253–264PubMedCrossRefGoogle Scholar
  11. 11.
    Drossman D, Corazziari E, Talley N, Thompson W, Whitehead W (2000) Rome II: the functional gastrointestinal disorders. Degnon, McLeanGoogle Scholar
  12. 12.
    Talley NJ, Phillips SF, Melton J 3rd, Wiltgen C, Zinsmeister AR (1989) A patient questionnaire to identify bowel disease. Ann Intern Med 111:671–674PubMedGoogle Scholar
  13. 13.
    Heitkemper M, Jarrett M, Burr R, Cain KC, Landis C, Lentz M, Poppe A (2005) Subjective and objective sleep indices in women with irritable bowel syndrome. Neurogastroenterol Motil 17:523–530PubMedCrossRefGoogle Scholar
  14. 14.
    American Academy of Sleep Medicine (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 22:667–689Google Scholar
  15. 15.
    The Atlas Task Force (1993) Recording and scoring leg movements. The Atlas Task Force. Sleep 16:748–759Google Scholar
  16. 16.
    Stiasny K, Oertel WH, Trenkwalder C (2002) Clinical symptomatology and treatment of restless legs syndrome and periodic limb movement disorder. Sleep Med Rev 6:253–265PubMedCrossRefGoogle Scholar
  17. 17.
    Klem G, Luders H, Jasper H, Elger C (1999) The ten-twenty electrode system of the International Federation. The International Federation of Clinical Neurophysiology. Electroencephalogr Clin Neurophysiol 52:3–6Google Scholar
  18. 18.
    Rechtschaffen A, Kales A (1968) A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. Brain Information Service/Brain Research Institute, University of California, Los AngelesGoogle Scholar
  19. 19.
    Kleiger RE, Stein PK, Bosner MS, Rottman JN (1992) Time domain measurements of heart rate variability. Cardiol Clin 10:487–498PubMedGoogle Scholar
  20. 20.
    Ori Z, Monir G, Weiss J, Sayhouni X, Singer DH (1992) Heart rate variability. Frequency domain analysis. Cardiol Clin 10:499–537PubMedGoogle Scholar
  21. 21.
    Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology (1996) Heart rate variability: standards of measurement, physiological interpretation and clinical use. Circulation 93:1043–1065Google Scholar
  22. 22.
    Berntson GG, Bigger JT Jr, Eckberg DL, Grossman P, Kaufmann PG, Malik M, Nagaraja HN, Porges SW, Saul JP, Stone PH, van der Molen MW (1997) Heart rate variability: origins, methods, and interpretive caveats. Psychophysiology 34:623–648PubMedCrossRefGoogle Scholar
  23. 23.
    Feinberg I, Floyd TC (1979) Systematic trends across the night in human sleep cycles. Psychophysiology 16:283–291PubMedCrossRefGoogle Scholar
  24. 24.
    Dijk DJ, Brunner DP, Borbely AA (1990) Time course of EEG power density during long sleep in humans. Am J Physiol 258:R650–R661PubMedGoogle Scholar
  25. 25.
    Armitage R, Hoffmann R, Trivedi M, Rush AJ (2000) Slow-wave activity in NREM sleep: sex and age effects in depressed outpatients and healthy controls. Psychiatry Res 95:201–213PubMedCrossRefGoogle Scholar
  26. 26.
    Hall M, Vasko R, Buysse D, Ombao H, Chen Q, Cashmere JD, Kupfer D, Thayer JF (2004) Acute stress affects heart rate variability during sleep. Psychosom Med 66:56–62PubMedCrossRefGoogle Scholar
  27. 27.
    Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213PubMedCrossRefGoogle Scholar
  28. 28.
    Backhaus J, Junghanns K, Broocks A, Riemann D, Hohagen F (2002) Test-retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia. J Psychosom Res 53:737–740PubMedCrossRefGoogle Scholar
  29. 29.
    Derogatis L (1994) SCL-90R: administration, scoring and procedures manual. NCS Pearson, MinneapolisGoogle Scholar
  30. 30.
    Derogatis L (1977) CP: conformation of dimensional structure of the SCL-90: a study in construct validation. J Clin Psychol 33:981–299CrossRefGoogle Scholar
  31. 31.
    Lazarus R, Folkman S (1996) Hassles and uplifts scales. Mind Garden, Palo AltoGoogle Scholar
  32. 32.
    Umetani K, Singer D, McCraty R, Atkinson M (1998) Twenty-four hour time domain heart rate variability and heart rate: relations to age and gender over nine decades. J Am Coll Cardiol 31:593–601PubMedCrossRefGoogle Scholar
  33. 33.
    O’Brien P (1984) Procedures for comparing samples with multiple endpoints. Biometrics 40:1079–1087PubMedCrossRefGoogle Scholar
  34. 34.
    Garrigues V, Mearin F, Badia X, Balboa A, Benavent J, Caballero A, Dominguez E, Diaz-Rubio M, Roset M, Figueras M, Cucala M (2007) Change over time of bowel habit in irritable bowel syndrome: a prospective, observational, 1-year follow-up study (RITMO study). Aliment Pharmacol Ther 25:323–332PubMedCrossRefGoogle Scholar
  35. 35.
    Mearin F, Baro E, Roset M, Badia X, Zarate N, Perez I (2004) Clinical patterns over time in irritable bowel syndrome: symptom instability and severity variability. Am J Gastroenterol 99:113–121PubMedCrossRefGoogle Scholar
  36. 36.
    Drossman DA, Morris CB, Hu Y, Toner BB, Diamant N, Leserman J, Shetzline M, Dalton C, Bangdiwala SI (2005) A prospective assessment of bowel habit in irritable bowel syndrome in women: defining an alternator. Gastroenterology 128:580–589PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Monica E. Jarrett
    • 1
  • Robert L. Burr
    • 1
  • Kevin C. Cain
    • 2
  • James D. Rothermel
    • 3
  • Carol A. Landis
    • 1
  • Margaret M. Heitkemper
    • 1
  1. 1.Department of Biobehavioral Nursing and Health SystemsUniversity of WashingtonSeattleUSA
  2. 2.Department of Biostatistics and Office of Nursing ResearchUniversity of WashingtonSeattleUSA
  3. 3.Department of Biobehavioral Nursing and Health Systems, School of Nursing Sleep LaboratoryUniversity of WashingtonSeattleUSA

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