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Migrating motor complex and sleep in health and irritable bowel syndrome

Abstract

The human migrating motor complex (MMC) and sleep cycle have a similar periodicity, and there is some contention as to whether these biorhythms are linked. In irritable bowel syndrome (IBS), episodes of intestinal dysmotility have been described almost exclusively during wakefulness, but IBS patients often complain of poor sleep, and it has been suggested that IBS patients have increased rapid eye movement (REM) sleep. This study sought to identify any associations between sleep stage and small intestinal motility and any objective sleep abnormalities in IBS. Nocturnal motility was recorded from six small intestinal sensors mounted on a fine nasoenteric catheter in eight IBS patients and 10 healthy volunteers. Polysomnography to determine sleep stage was recorded simultaneously. The proportions of time awake, in non-REM and REM sleep were similar in controls and IBS. REM latency did not differ between the two groups despite increased depression in the IBS patients (Hamilton Depression Rating of 8.3±1.7 in IBS, 3.0±0.7 in controls,P<0.01). Nocturnal motility was similar, with phase I occupying most of the MMC cycles. There was no temporal association between MMCs and sleep stage, with no synchrony of phase III for REM episodes. The mean motility index of 4.5±0.4 during wakefulness was greater than during all sleep stages (P<0.05). During non-REM sleep stages 1 and 2, motility index of 3.2±0.3 was greater than 2.3±0.2 during stages 3 and 4 (P<0.05), but similar to motility index of 3.3±0.4 during REM sleep. Thus, sleep architecture and nocturnal small intestinal motility are normal in IBS. In health and IBS, sleep cycles and MMC cycles are independent, but motility is quantitatively influenced by sleep stage and is inversely related to the depth of sleep.

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References

  1. 1.

    Ruckebusch Y, Bueno L: Electrical spiking of the small intestine as an ultradian rhythm. Proc Int Union Physiol Sci 12:789, 1977

    Google Scholar 

  2. 2.

    Finch PM, Ingram DM, Henstridge JD, Catchpole BN: Relationship of fasting gastroduodenal motility to the sleep cycle. Gastroenterology 83:605–612, 1982

    PubMed  Google Scholar 

  3. 3.

    Kumar D, Idzikowski C, Wingate DL, Soffer EE, Thompson P, Siderfin C: Relationship between enteric migrating motor complex and the sleep cycle. Am J Physiol 259:G983-G990, 1990

    PubMed  Google Scholar 

  4. 4.

    Thompson DG, Wingate DL, Archer L, Benson MJ, Green WJ, Hardy RJ: Normal patterns of human upper small bowel motor activity recorded by prolonged telemetry. Gut 21:500–506, 1980

    PubMed  Google Scholar 

  5. 5.

    Kellow JE, Gill RC, Wingate DL: Prolonged ambulant recordings of small bowel motility demonstrate abnormalities in the irritable bowel syndrome. Gastroenterology 98:1208–1218, 1990

    PubMed  Google Scholar 

  6. 6.

    Kumar D, Wingate D, Ruckebusch Y: Circadian variation in the propagation velocity of the migrating motor complex. Gastroenterology 91:926–930, 1986

    PubMed  Google Scholar 

  7. 7.

    Helm JD, Kramer P, MacDonald RM, Ingelfinger FJ: Changes in motility of the human small intestine during sleep. Gastroenterology 10:135–137, 1948

    Google Scholar 

  8. 8.

    Ritchie HD, Thompson DG, Wingate DL: Diurnal variation in human jejunal fasting motor activity. J Physiol 305:54–55P, 1980

    Google Scholar 

  9. 9.

    Schmidt T, Widmer R, Wilmer A, Pfeiffer A, Kaess H: 24-Hour monitoring of duodenojejunal motility: The influence of sleep and awakening. Gastroenterology 100:A491, 1991

  10. 10.

    Kellow JE, Eckersley GM, Jones M: Enteric and central contributions to intestinal dysmotility in irritable bowel syndrome. Dig Dis Sci 37:168–174, 1992

    PubMed  Google Scholar 

  11. 11.

    Whorwell PJ, McCallum M, Creed FH, Roberts CT: Noncolonic features of irritable bowel syndrome. Gut 27:37–40, 1986

    PubMed  Google Scholar 

  12. 12.

    Goldsmith G, Levin JS: Effect of sleep quality on symptoms of irritable bowel syndrome. Dig Dis Sci 38:1809–1814, 1993

    PubMed  Google Scholar 

  13. 13.

    Hardo PG, Jones SC, Axon ATR, Chalmers D: Irritable bowel syndrome and sleep disturbance. Gastroenterology 104:A518, 1993

    Google Scholar 

  14. 14.

    Kumar D, Thompson PD, Wingate DL, Vesselinova-Jenkins CK, Libby G: Abnormal REM sleep in the irritable bowel syndrome. Gastroenterology 103:12–17, 1992

    PubMed  Google Scholar 

  15. 15.

    Thompson WG, Dotevall G, Drossman DA, Heaton KW, Kruis W: Irritable bowel syndrome: Guidelines for the diagnosis. Gastroenterol Int 2:92–95, 1989

    Google Scholar 

  16. 16.

    Gorard DA, Libby GW, Farthing MJG: Ambulatory small intestinal motility in “diarrhoea” predominant irritable bowel syndrome. Gut 35:203–210, 1994

    PubMed  Google Scholar 

  17. 17.

    Kellow JE, Borody TJ, Phillips SF, Tucker RL, Haddad AC: Human interdigestive motility: Variations in patterns from esophagus to colon. Gastroenterology 91:386–395, 1986

    PubMed  Google Scholar 

  18. 18.

    Rechtschaffen A, Kales AA (eds): A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects (National Institutes of Health publication No. 204). Washington, DC, US Government Printing Office, 1968

    Google Scholar 

  19. 19.

    Hamilton M: A rating scale for depression. J Neurol Neurosurg Psychiatry 23:56–61, 1960

    PubMed  Google Scholar 

  20. 20.

    Zigmond AS, Snaith RP: The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370, 1983

    PubMed  Google Scholar 

  21. 21.

    American Psychiatric Association: Diagnostic and statistical manual of mental disorders DSM-III-R, 3rd ed (rev). Washington, DC, American Psychiatric Association, 1987

    Google Scholar 

  22. 22.

    Summers RW, Anuras S, Green J: Jejunal manometry patterns in health, partial intestinal obstruction, and pseudoobstruction. Gastroenterology 85:1290–1300, 1983

    PubMed  Google Scholar 

  23. 23.

    Quigley EMM, Borody TJ, Phillips SF, Wienbeck M, Tucker RL, Haddad A: Motility of the terminal ileum and ileocecal sphincter in healthy humans. Gastroenterology 87:857–866, 1984

    PubMed  Google Scholar 

  24. 24.

    Quigley EMM: Intestinal manometry—technical advances, clinical limitations. Dig Dis Sci 37:10–13, 1992

    PubMed  Google Scholar 

  25. 25.

    Kellow JE, Phillips SF: Altered small bowel motility in irritable bowel syndrome is correlated with symptoms. Gastroenterology 92:1885–1893, 1987

    PubMed  Google Scholar 

  26. 26.

    Kupfer DJ: REM latency: A psychobiologic marker for primary depressive disease. Biol Psychiatry 11:159–174, 1976

    PubMed  Google Scholar 

  27. 27.

    Gillin JC, Duncan W, Pettigrew KD, Frankel BL, Snyder F: Successful separation of depressed, normal, and insomniac subjects by EEG sleep data. Arch Gen Psychiatry 36:85–90, 1979

    PubMed  Google Scholar 

  28. 28.

    Reynolds CF: Sleep and affective disorders. A minireview. Psychiatr Clin North Am 10:583–591, 1987

    PubMed  Google Scholar 

  29. 29.

    Blanchard EB, Scharff L, Schwarz SP, Suls JM, Barlow DH: The role of anxiety and depression in the irritable bowel syndrome. Behav Res Ther 28:401–405, 1990

    PubMed  Google Scholar 

  30. 30.

    Talley NJ, Camilleri M, Orkin BA, Kramlinger KG: Effect of cyclical unipolar depression on upper gastrointestinal motility and sleep. Gastroenterology 97:775–777, 1989

    PubMed  Google Scholar 

  31. 31.

    McRae S, Younger K, Thompson DG, Wingate DL: Sustained mental stress alters human jejunal motor activity. Gut 23:404–409, 1982

    PubMed  Google Scholar 

  32. 32.

    Kumar D, Wingate DL: The irritable bowel syndrome: A paroxysmal motor disorder. Lancet 2:973–977, 1985

    PubMed  Google Scholar 

  33. 33.

    Tassinari CA, Coccagna G, Mantovani M, Dalla Bernardina D, Spire JP, Mancia D, Vela A, Vallicioni P: Duodenal EMG activity during sleep in man.In The Nature of Sleep. UD Jovanovic (ed). Stuttgart, Fischer-Verlag, 1973, pp 55–58

    Google Scholar 

  34. 34.

    Castiglione F, Emde C, Armstrong D, Schneider C, Bauerfeind P, Stacher G, Blum AL: Nocturnal oesophageal motor activity is dependent on sleep stage. Gut 34:1653–1659, 1993

    PubMed  Google Scholar 

  35. 35.

    Baust W, Rohrwasser W: Gastric motility and pH during natural human sleep. Pflügers Arch 305:229–240, 1969

    Google Scholar 

  36. 36.

    Furukawa Y, Cook IJ, Panagopoulos V, McEvoy RD, Sharp DJ, Simula M: Relationship between sleep patterns and human colonic motor patterns. Gastroenterology 107:1372–1381, 1994

    PubMed  Google Scholar 

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Correspondence to D. A. Gorard MD.

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This work was supported by the Priory Hospitals Group.

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Gorard, D.A., Vesselinova-Jenkins, C.K., Libby, G.W. et al. Migrating motor complex and sleep in health and irritable bowel syndrome. Digest Dis Sci 40, 2383–2389 (1995). https://doi.org/10.1007/BF02063242

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Key words

  • sleep
  • intestine
  • migrating motor complex
  • motility
  • irritable bowel syndrome