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Characterization of relations among sleep, inflammation, and psychiatric dysfunction in depressed youth with Crohn
David Benhayon1, Ada Youk, F Nicole McCarthy
1Medical Coping Clinic, Department of Gastroenterology, Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA. benhayond@upmc.edu
Insights
Sleep disturbance is common in pediatric Crohn disease (CD) patients with depression and linked to pain and anxiety. The type of sleep disturbance may depend on disease activity, suggesting tailored interventions for inflammatory bowel disease (IBD).
Area of Science:
- Pediatric gastroenterology
- Psychiatry
- Sleep medicine
Background:
- Inflammatory bowel disease (IBD), particularly Crohn disease (CD), is linked to sleep disturbance and psychiatric dysfunction.
- Pediatric CD patients often experience increased psychiatric issues, necessitating further research into related factors.
Purpose of the Study:
- To investigate the relationship between sleep disturbance, inflammation, and psychiatric dysfunction in pediatric patients with Crohn disease and depression.
- To differentiate sleep disturbance patterns based on disease activity and psychiatric comorbidities.
Main Methods:
- A study involving 96 pediatric CD patients with depression and 19 healthy controls.
- Utilized the Pittsburgh Sleep Quality Index (PSQI) for sleep assessment, alongside measures for depression, anxiety, and pain.
- Employed factor analysis and regression analyses to examine associations between sleep, psychosocial factors, and biological markers of inflammation.
Main Results:
- Depressed youth with CD exhibited greater sleep disturbance than controls, correlated with pain, depression, and anxiety.
- Factor analysis revealed two sleep disturbance patterns: 'Qualitative' (linked to pain, anxiety, disease activity) and 'Quantitative' (linked to disease activity).
- Inflammatory biomarkers were not directly associated with overall sleep disturbance but showed a relation to quantitative sleep aspects.
Conclusions:
- Sleep disturbance in depressed pediatric CD patients varies with disease activity.
- Interventions for sleep disturbance in pediatric CD should be tailored to the specific type of disturbance and illness activity.
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.
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