Characterization of Relations Among Sleep, Inflammation, and Psychiatric Dysfunction in Depressed Youth With Crohn Disease

Benhayon, David*; Youk, Ada; McCarthy, F. Nicole*; Davis, Stephanie§; Keljo, David J.||; Bousvaros, Athos; Fairclough, Diane#; Kupfer, David; Buysse, Daniel J.; Szigethy, Eva M.*

Journal of Pediatric Gastroenterology & Nutrition: September 2013 - Volume 57 - Issue 3 - p 335–342
doi: 10.1097/MPG.0b013e31829641df
Original Articles: Gastroenterology

Objectives: Recent reports demonstrate a link between inflammatory bowel disease (IBD) and sleep disturbance. Increased psychiatric dysfunction is consistently reported in patients with IBD. Our objective is to examine relations among sleep disturbance, inflammation, and psychiatric dysfunction in a pediatric population with Crohn disease (CD) and depression.

Methods: Pediatric patients with CD with depression (n = 96) and healthy controls (n = 19) completed measures of sleep (Pittsburgh Sleep Quality Index [PSQI]), depression, anxiety, and abdominal pain, and provided blood for inflammatory markers. CD activity was determined by the Pediatric Crohn's Disease Activity Index. Factor analysis was performed on subscales of the PSQI to derive measures of sleep disturbance. Univariate and multivariate regression analyses assessed relations between sleep disturbance, psychosocial, and biological measures of CD and psychiatric dysfunction.

Results: Sleep disturbance in depressed youth with CD was significantly greater than healthy controls, and was significantly related to measures of abdominal pain, depression, and anxiety, but not biomarkers of inflammation. Factor analysis of the PSQI demonstrated a 2-factor solution. The first factor, termed “Qualitative,” included Subjective Sleep Quality, Daytime Dysfunction, Sleep Disturbance, and Sleep Latency, whereas the second factor, “Quantitative,” consisted of Habitual Sleep Efficiency and Sleep Duration. This factor showed a significant relation to inflammatory markers. Multivariate modeling suggested that qualitative sleep disturbance was predicted by disease activity, pain, and anxiety, whereas quantitative sleep disturbance was predicted by disease activity.

Conclusions: These results indicate that sleep disturbance in depressed youth with CD differs depending upon illness activity. Patients may require different interventions depending upon the sleep disturbance exhibited.

*Medical Coping Clinic, Department of Gastroenterology, Children's Hospital of Pittsburgh

Department of Psychiatry, Western Psychiatric Institute and Clinic

Department of Biostatistics

§Department of Psychology

||Department of Gastroenterology, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA

Department of Gastroenterology, Boston Children's Hospital, Harvard University, Boston, MA

#Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO.

Address correspondence and reprint requests to David Benhayon, Children's Hospital of Pittsburgh, 4401 Penn Avenue, Plaza Building, 3rd Floor, Pittsburgh, PA 15224 (e-mail:

Received 11 September, 2012

Accepted 2 April, 2013

This research was funded by NIMH R01 MH077770-01A2, NIMH 5T32MH016804-30, and an award from the American Psychiatric Institute for Research and Education (APIRE).

The authors report no conflicts of interest.

© 2013 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,