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Assessment of the Relationship Between Quality of Sleep and Disease Activity in Inflammatory Bowel Disease Patients

Ali, Tauseef MD*,†; Madhoun, Mohammad F. MD; Orr, William C. PhD‡,§; Rubin, David T. MD

doi: 10.1097/MIB.0b013e3182a0ea54
Original Clinical Articles

Purpose: Poor sleep quality is associated with adverse health consequences. Sleep disturbances can impact the immune function and process of inflammation. The relationship between sleep quality and the inflammatory bowel disease (IBD) has not been well studied.

Methods: A prospective observational cohort study was performed to assess the correlation of the quality of sleep and disease activity in IBD. We used the Pittsburgh Sleep Quality Index (PSQI) to measure sleep quality. IBD disease activity was measured by using the Harvey–Bradshaw Index or Modified Mayo Score.

Results: Forty-one patients were enrolled with mean age of 37 ± 15.4 years and 27 (66%) women. Abnormal PSQI was present in all 23 (100%) of the clinically active patients and in 13 (72%) of those with inactive disease (odds ratio = 2.8, P = 0.007). All 30 patients with histologic evidence of inflammation on recent ileocolonoscopy also had abnormal PSQI scores, which were independent of their clinical disease activity status. Only 6 of 11 patients with histologically quiescent disease had abnormal PSQI scores (odds ratio = 6.0, P < 0.0001). There was no difference in disease type, use of steroids, the presence of depression or anxiety, and body mass index between the patients with normal and abnormal sleep. An abnormal PSQI had a positive predictive value for histologic inflammatory activity of 83%.

Conclusions: Our data show a strong association between clinically active IBD and poor sleep quality and demonstrate that patients in clinical remission with abnormal sleep have a high likelihood of subclinical disease activity.

Article first published online 13 August 2013

*OU Physicians Inflammatory Bowel Disease Center, Oklahoma City, Oklahoma;

Section of Digestive Diseases and Nutrition, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma;

Lynn Health Science Institute, Oklahoma City, Oklahoma;

§University of Chicago Inflammatory Bowel Disease Center, Chicago, Illinois; and

College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.

Reprints: Tauseef Ali, MD, OU Physicians Inflammatory Bowel Disease Center, WP1345, 920 S. L. Young Boulevard, Oklahoma City, OK (e-mail:

The authors have no conflicts of interest to disclose.

Received June 11, 2013

Accepted June 17, 2013

© Crohn's & Colitis Foundation of America, Inc.
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