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The Relationship Between Sleep Disturbance and Disease Activity in Pediatric Patients With Inflammatory Bowel Disease

Jarasvaraparn, Chaowapong*; Zlomke, Kimberly; Vann, Noelle C.; Wang, Bin; Crissinger, Karen D.§; Gremse, David A.§

Journal of Pediatric Gastroenterology and Nutrition: February 2019 - Volume 68 - Issue 2 - p 237–243
doi: 10.1097/MPG.0000000000002156
Original Articles: Gastroenterology: Inflammatory Bowel Disease

Objective: The aim of this prospective cross sectional study was to assess the prevalence of sleep disturbance in children with inflammatory bowel disease (IBD), including the relationships between sleep, inflammatory markers, and disease activity of pediatric patients with IBD.

Methods: Pediatric patients with IBD and parents were enrolled in the study. Patients completed the Pittsburgh Sleep Quality Index (PSQI), the Pediatric Daytime Sleepiness Scale, and the Adolescent Sleep Wake Scale (ASWS) surveys. Parents completed the Child Sleep Habits Questionnaire (CSHQ). Disease activity for Crohn disease (CD) was determined by the Pediatric Crohn Disease Activity Index and the Pediatric Ulcerative Colitis Activity Index was used to define disease activity in ulcerative colitis (UC)/indeterminate colitis patients.

Results: Fifty-three pediatric patients with IBD (38 CD, 12 UC, and 3 indeterminate colitis) participated in the study. The significant correlations between the CSHQ and Pediatric Crohn Disease Activity Index (P = 0.002) and the PSQI and Pediatric Ulcerative Colitis Activity Index (P = 0.04) were found. Youth with UC and indeterminate colitis significantly reported more sleep disturbance than patients with CD, (P = 0.03, 0.05, and 0.04; PSQI, Pediatric Daytime Sleepiness Scale, ASWS, respectively). Patients self-reported significantly more sleep disturbance than was observed by parents (P < 0.0001). This study showed the significant correlations between CSHQ score compared to erythrocyte sedimentation rate and albumin (P = 0.001 and 0.03, respectively).

Conclusions: Results suggest that increased disease activity is associated with adverse effects on sleep quality. Based on the results of this study, pediatric patients with IBD should be screened for sleep disturbance.

*Department of Pediatrics

Department of Psychology

Department of Mathematics and Statistics

§Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of South Alabama, Mobile, AL.

Address correspondence and reprint requests to Chaowapong Jarasvaraparn, MD, Department of Pediatrics, University of South Alabama, 1700 Center St., Mobile, AL 36608 (e-mail:

Received 21 May, 2018

Accepted 31 August, 2018

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Funding source: Statistical analysis in this project was supported by a grant from the Simons Foundation (422535, Bin Wang) and an award from the National Center for Advancing Translational Sciences of the National Institutes of Health (UL1TR001417).

The authors report no conflicts of interest.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,