Impaired objective and subjective sleep in children and adolescents with inflammatory bowel disease compared to healthy controls
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Laura Mählmann1, Markus Gerber2, Raoul I Furlano3
1University of Basel, Psychiatric Clinics (UPK), Centre for Affective, Stress and Sleep Disorders (ZASS), Basel, Switzerland; Maastricht Economic and Social Research Institute on Innovation and Technology (MERIT), Maastricht University, Maastricht, The Netherlands.
Insights
Children and adolescents with active inflammatory bowel disease (IBD) experience impaired objective sleep. Sleep quality and inflammation markers are complexly associated in pediatric IBD patients.
Area of Science:
- Pediatric Gastroenterology
- Sleep Medicine
- Immunology
Background:
- Inflammatory bowel disease (IBD) is linked to poor sleep and inflammation.
- Sleep disturbances are common in IBD patients.
- Limited data exists on sleep in pediatric IBD populations.
Purpose of the Study:
- To compare subjective and objective sleep in children and adolescents with IBD versus healthy controls.
- To investigate the relationship between sleep and inflammation markers in pediatric IBD.
- To identify differences in sleep patterns between IBD patients in remission and those with active disease.
Main Methods:
- 47 participants (23 with IBD, 24 healthy controls) aged 13.88 years.
- IBD group split into remission (IBD-RE) and active disease (IBD-AD) subgroups.
- Subjective sleep assessed via questionnaires; objective sleep via electroencephalography; inflammatory markers (CRP, ESR) measured.
Main Results:
- IBD-AD patients exhibited poorer objective sleep (more awakenings, longer latency, less stage 3 sleep) than HC and IBD-RE.
- Higher ESR correlated with more stage 4 sleep.
- Nonlinear relationships found between ESR and subjective sleep quality, and between CRP and sleep latency.
Conclusions:
- Objective sleep is impaired in pediatric IBD patients with active disease.
- Sleep quality and inflammation indices are complexly associated in this group.
- Subjective sleep quality assessment is recommended for pediatric IBD care to indicate objective sleep issues and inflammation.
Objective:
Poor sleep and higher inflammation markers are associated, and impaired sleep quality is common among patients with inflammatory bowel disease (IBD). However, information on sleep among children and adolescents with IBD is currently lacking. The aims of the present study were to compare subjective and objective sleep of children and adolescents with IBD with healthy controls and to shed more light on the relationship between sleep and inflammation. We expected that poor sleep, as assessed via sleep electroencephalography recordings, would be observed among participants with IBD, but particularly among participants in an active state of disease. Furthermore, we expected that poor sleep and higher inflammatory markers would be associated.
Methods:
A total of 47 children and adolescents participated in the study; 23 were diagnosed with IBD (mean age: 13.88 years, 44% female). The IBD group was divided into a medically well adjusted "remission-group" (IBD-RE; n = 14) and a group with an "active state of disease" (IBD-AD; n = 8). Healthy controls (HC; n = 24) were age and gender matched. Participants completed self-rating questionnaires for subjective sleep disturbances. Anthropometric data, acute and chronic inflammatory markers (C-reactive protein [CRP] and erythrocyte sedimentation rate [ESR]) and objective sleep were considered.
Results:
Compared to HC and IBD-RE, IBD-AD patients showed impaired objective sleep patterns (eg, more awakenings, longer sleep latency, and reduced stage 3 sleep). Linear relationships described the correlation between higher ESR and more stage 4 (minutes, percentage) sleep. Nonlinear relationships described the relation between ESR and subjective sleep quality (inverse U-shaped) and between CRP and sleep latency (U-shaped).
Conclusion:
In children and adolescents with an active IBD, objective sleep was impaired and overall sleep quality and inflammation indices were associated in a complex manner. It seems advisable to include assessment of subjective sleep quality in the care of pediatric IBD patients as an additional indicator for objective sleep disturbances and inflammation.
Trial Registration Number:
NCT02264275.
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