Skip to main content

Advertisement

SpringerLink
Log in

Sleep Characteristics and Rest–Activity Rhythms Are Associated with Gastrointestinal Symptoms Among Adults with Inflammatory Bowel Disease

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Sleep disturbance is common in inflammatory bowel disease (IBD) and is associated with poorer quality of life and increased disease activity; however, sleep is a multidimensional process, and little is known about specific sleep characteristics and rest–activity rhythms (RARs) in this population.

Aims

The purposes were to (1) describe sleep characteristics and RARs; (2) compare sleep characteristics and RARs and GI symptoms by disease activity; and (3) describe associations between sleep characteristics, RARs, and GI symptoms among adults with IBD.

Methods

We conducted a cross-sectional study of adults with IBD. We measured sleep characteristics and RARs (continuous wrist actigraphy); GI symptoms (PROMIS-GI); and disease activity (physicians’ global assessment). We conducted cosinor and nonparametric analyses to compute RAR variables and bivariate analyses to address the aims.

Results

The sample included 37 participants [age M = 38 years (SD = 13.8) and 21 (56.8%) female], of whom 23 (60.6%) were in remission. Sleep efficiency [M = 82.91% (SD 5.35)] and wake after sleep onset (WASO) [M = 42.26 min (SD 18.57)] were not associated with disease activity. Inter-daily stability of the RAR was associated with heartburn/reflux (r = − .491, p = .005) and gas/bloating (r = − .469, p = .008). Intra-daily variability of the RAR was associated with heartburn/reflux (r = .421, p = .018).

Conclusions

People with IBD may have disrupted RARs, which are associated with GI symptoms. Research is needed to improve understanding of these associations and to develop interventions to improve these characteristics in adults with IBD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Shivashankar R, Tremaine WJ, Harmsen WS, Loftus EV. Incidence and prevalence of crohn’s disease and ulcerative colitis in Olmsted County, Minnesota from 1970 through 2010. Clin Gastroenterol Hepatol. 2017;15:857–863.

    Article  Google Scholar 

  2. Conley S, Proctor DD, Jeon S, Sandler RS, Redeker NS. Symptoms clusters in adults with inflammatory bowel disease. Res Nurs Health. 2017;40:424–434.

    Article  Google Scholar 

  3. Borbely AA, Daan S, Wirz-Justice A, Deboer T. The two-process model of sleep regulation: a reappraisal. J Sleep Res. 2016;25:131–143. https://doi.org/10.1111/jsr.12371.

    Article  PubMed  Google Scholar 

  4. Gingold-Belfer R, Peled N, Levy S, et al. Impaired sleep quality in Crohn’s disease depends on disease activity. Dig Dis Sci. 2013;. https://doi.org/10.1007/s10620-013-2890-8.

    Article  PubMed  Google Scholar 

  5. 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;19:2440–2443. https://doi.org/10.1097/MIB.0b013e3182a0ea54.

    Article  PubMed  Google Scholar 

  6. Ranjbaran Z, Keefer L, Farhadi A, Stepanski E, Sedghi S, Keshavarzian A. Impact of sleep disturbances in inflammatory bowel disease. J Gastroenterol Hepatol. 2007;22:1748–1753.

    Article  Google Scholar 

  7. Graff LA, Vincent N, Walker JR, et al. A population-based study of fatigue and sleep difficulties in inflammatory bowel disease. Inflamm Bowel Dis. 2011;17:1882–1889. https://doi.org/10.1002/ibd.21580.

    Article  PubMed  Google Scholar 

  8. Chang S, Malter L, Hudesman D. Disease monitoring in inflammatory bowel disease. World J Gastroenterol. 2015;21:11246–11259. https://doi.org/10.3748/wjg.v21.i40.11246.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Tang Y, Preuss F, Turek FW, Jakate S, Keshavarzian A. Sleep deprivation worsens inflammation and delays recovery in a mouse model of colitis. Sleep Med. 2009;10:597–603. https://doi.org/10.1016/j.sleep.2008.12.009.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Preuss F, Tang Y, Laposky AD, Arble D, Keshavarzian A, Turek FW. Adverse effects of chronic circadian desynchronization in animals in a “challenging” environment. Am J Physiol Regul Integr Comp Physiol. 2008;295:R2034–R2040. https://doi.org/10.1152/ajpregu.00118.2008.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Smith MT, McCrae CS, Cheung J, et al. Use of actigraphy for the evaluation of sleep disorders and circadian rhythm sleep-wake disorders: an american academy of sleep medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med. 2018;14:1209–1230. https://doi.org/10.5664/jcsm.7228.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Ananthakrishnan AN, Long MD, Martin CF, Sandler RS, Kappelman MD. Sleep disturbance and risk of active disease in patients with Crohn’s disease and ulcerative colitis. Clin Gastroenterol Hepatol. 2013;. https://doi.org/10.1016/j.cgh.2013.01.021.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Neikrug AB, Rissling M, Trofimenko V, et al. Bright light therapy protects women from circadian rhythm desynchronization during chemotherapy for breast cancer. Behav Sleep Med. 2012;10:202–216. https://doi.org/10.1080/15402002.2011.634940.

    Article  PubMed  Google Scholar 

  14. Sobolewska-Wlodarczyk A, Wlodarczyk M, Szemraj J, Stec-Michalska K, Fichna J, Wisniewska-Jarosinska M. Circadian rhythm abnormalities—association with the course of inflammatory bowel disease. Pharmacol Rep. 2016;68:847–851. https://doi.org/10.1016/j.pharep.2016.04.007.

    Article  PubMed  Google Scholar 

  15. Huang Y, Liu R, Wang Q, Van Someren EJW, Xu H, Zhou J. Age-associated difference in circadian sleep–wake and rest–activity rhythms. Physiol Behav. 2002;76:597–603. https://doi.org/10.1016/s0031-9384(02)00733-3.

    Article  CAS  PubMed  Google Scholar 

  16. Turner D, Griffiths AM, Mack D, et al. Assessing disease activity in ulcerative colitis: Patients or their physicians? Inflamm Bowel Dis. 2010;16:651–656. https://doi.org/10.1002/ibd.21088.

    Article  PubMed  Google Scholar 

  17. Conley S, Knies A, Batten J, et al. Agreement between actigraphic and polysomnographic measures of sleep in adults with and without chronic conditions: a systematic review and meta-analysis. Sleep Med Rev. 2019;46:151–160.

    Article  Google Scholar 

  18. Ancoli-Israel S, Cole R, Alessi C, Chambers M, Moorcroft W, Pollak C. The role of actigraphy in the study of sleep and circadian rhythms. American academy of sleep medicine review paper. Sleep. 2003;26:342–392.

    Article  Google Scholar 

  19. Hirshkowitz M, Whiton K, Albert SM, et al. National sleep foundation’s sleep time duration recommendations: methodology and results summary. Sleep Health. 2015;1:40–43.

    Article  Google Scholar 

  20. Ohayon M, Wickwire EM, Hirshkowitz M, et al. National sleep foundation’s sleep quality recommendations: first report. Sleep Health. 2017;3:6–19.

    Article  Google Scholar 

  21. Agarwal R, Light RP. Sleep and activity in chronic kidney disease: a longitudinal study. Clin J Am Soc Nephrol. 2011;6:1258–1265. https://doi.org/10.2215/CJN.10581110.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Brown AC, Smolensky MH, D’Alonzo GE, Redman DP. Actigraphy: a means of assessing circadian patterns in human activity. Chronobiol Int. 1990;7:125–133.

    Article  CAS  Google Scholar 

  23. Berger AM, Farr LA, Kuhn BR, Fischer P, Agrawal S. Values of sleep/wake, activity/rest, circadian rhythms, and fatigue prior to adjuvant breast cancer chemotherapy. J Pain Symptom Manage. 2007;33:398–409.

    Article  Google Scholar 

  24. Berger AM, Wielgus K, Hertzog M, Fischer P, Farr L. Patterns of circadian activity rhythms and their relationships with fatigue and anxiety/depression in women treated with breast cancer adjuvant chemotherapy. Support Care Cancer. 2010;18:105–114. https://doi.org/10.1007/s00520-009-0636-0.

    Article  PubMed  Google Scholar 

  25. Cavalcanti-Ferreira P, Berk L, Daher N, et al. A nonparametric methodological analysis of rest-activity rhythm in type 2 diabetes. Sleep Sci. 2018;11:281–289. https://doi.org/10.5935/1984-0063.20180044.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Wolfe F, Michaud K, Li T. Sleep disturbance in patients with rheumatoid arthritis: evaluation by medical outcomes study and visual analog sleep scales. J Rheumatol. 2006;33:1942–1951.

    PubMed  Google Scholar 

  27. Spiegel BM, Hays RD, Bolus R, et al. Development of the NIH patient-reported outcomes measurement information system (PROMIS) gastrointestinal symptom scales. Am J Gastroenterol. 2014;109:1804–1814. https://doi.org/10.1038/ajg.2014.237.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Halberg F, Visscher MB, Flink EB, Berge K, Bock F. Diurnal rhythmic changes in blood eosinophil levels in health and in certain diseases. J Lancet. 1951;71:312–319.

    CAS  PubMed  Google Scholar 

  29. Halberg F, Cornelissen G, Katinas G, et al. Transdisciplinary unifying implications of circadian findings in the 1950s. J Circadian Rhythms. 2003;1:2–3391. https://doi.org/10.1186/1740-3391-1-2.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Blume C, Santhi N, Schabus M. ‘nparACT’ package for R: a free software tool for the non-parametric analysis of actigraphy data. MethodsX. 2016;3:430–435. https://doi.org/10.1016/j.mex.2016.05.006.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Goncalves BS, Cavalcanti PR, Tavares GR, Campos TF, Araujo JF. Nonparametric methods in actigraphy: an update. Sleep Sci. 2014;7:158–164. https://doi.org/10.1016/j.slsci.2014.09.013.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Goncalves BS, Adamowicz T, Louzada FM, Moreno CR, Araujo JF. A fresh look at the use of nonparametric analysis in actimetry. Sleep Med Rev. 2015;20:84–91. https://doi.org/10.1016/j.smrv.2014.06.002.

    Article  CAS  PubMed  Google Scholar 

  33. Polit DF, Beck CT. Nursing Research. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2012.

    Google Scholar 

  34. Paixao DL, Poyares D, de Paula MS, et al. Evaluation of home polysomnography findings, quality of sleep, and fatigue in inflammatory bowel disease: a case series. J Clin Sleep Med. 2019;15:39–45. https://doi.org/10.5664/jcsm.7566.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Qazi T, Verma R, Hamilton MJ, Kaplan ER, Redline S, Burakoff R. The use of actigraphy differentiates sleep disturbances in active and inactive Crohn’s disease. Inflamm Bowel Dis. 2018;. https://doi.org/10.1093/ibd/izy324.

    Article  Google Scholar 

  36. Caruso CC, Lusk SL, Gillespie BW. Relationship of work schedules to gastrointestinal diagnoses, symptoms, and medication use in auto factory workers. Am J Ind Med. 2004;46:586–598. https://doi.org/10.1002/ajim.20099.

    Article  PubMed  Google Scholar 

  37. Nojkov B, Rubenstein JH, Chey WD, Hoogerwerf WA. The impact of rotating shift work on the prevalence of irritable bowel syndrome in nurses. Am J Gastroenterol. 2010;105:842–847. https://doi.org/10.1038/ajg.2010.48.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Abdalla MI, Sandler RS, Kappelman MD, et al. Prevalence and impact of inflammatory bowel disease-irritable bowel syndrome on patient-reported outcomes in CCFA partners. Inflamm Bowel Dis. 2017;23:325–331. https://doi.org/10.1097/MIB.0000000000001017.

    Article  PubMed  Google Scholar 

  39. Kochar B, Martin CF, Kappelman MD, et al. Evaluation of gastrointestinal patient reported outcomes measurement information system (GI-PROMIS) symptom scales in subjects with inflammatory bowel diseases. Am J Gastroenterol. 2018;113:72–79. https://doi.org/10.1038/ajg.2017.240.

    Article  PubMed  Google Scholar 

  40. Keefer L, Stepanski EJ, Ranjbaran Z, Benson LM, Keshavarzian A. An initial report of sleep disturbance in inactive inflammatory bowel disease. J Clin Sleep Med. 2006;2:409–416.

    Article  Google Scholar 

  41. Sofia MA, Lipowska AM, Perez EY, Zmeter N, Kavitt RT, Rubin DT. Heartburn in Crohn’s disease is associated with increased disease activity, poor sleep quality and prior ileocecectomy. J Crohn’s Colitis. 2017;11:S173–S174.

    Article  Google Scholar 

  42. Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD, Clinical Guidelines Committee of the American College of Physicians. Management of chronic insomnia disorder in adults: a clinical practice guideline from the american college of physicians. Ann Intern Med. 2016;165:125–133. https://doi.org/10.7326/m15-2175.

    Article  PubMed  Google Scholar 

  43. van Maanen A, Meijer AM, van der Heijden KB, Oort FJ. The effects of light therapy on sleep problems: a systematic review and meta-analysis. Sleep Med Rev. 2016;29:52–62. https://doi.org/10.1016/j.smrv.2015.08.009.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

This work was supported by American Nurses Foundation Eastern Nursing Eastern Research Scholar Award (PI Samantha Conley); Self and Family Management T32 (PI Margaret Grey T32NR008346).

Author information

Authors and Affiliations

  1. Yale School of Nursing, 400 West Campus Dr., Orange, CT, 06477, USA

    Samantha Conley, Sangchoon Jeon, Vanessa Lehner, Deborah D. Proctor & Nancy S. Redeker

Authors
  1. Samantha Conley
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sangchoon Jeon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vanessa Lehner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Deborah D. Proctor
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nancy S. Redeker
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Samantha Conley.

Ethics declarations

Conflict of interest

Deborah Proctor was supported by AbbVie (grant support and consulting) and Paraxel (grant support) not in connection with this study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Conley, S., Jeon, S., Lehner, V. et al. Sleep Characteristics and Rest–Activity Rhythms Are Associated with Gastrointestinal Symptoms Among Adults with Inflammatory Bowel Disease. Dig Dis Sci 66, 181–189 (2021). https://doi.org/10.1007/s10620-020-06213-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-020-06213-6

Keywords

Search

Navigation