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Relationship between disease activity index and sleep disorders in children with inflammatory bowel diseases
Dilsat Gundogdu1, Nafiye Urgancı2, Merve Usta3
1Pediatrics, SBU Sisli Hamidiye Etfal Training and Research Hospital, MD, Istanbul, Turkey.
Insights
Pediatric patients with inflammatory bowel disease (IBD) experience significant sleep disturbances, strongly linked to disease activity. The Pittsburgh Sleep Quality Index (PSQI) and disease activity indices effectively predict sleep disorders in these children.
Area of Science:
- Gastroenterology
- Pediatrics
- Sleep Medicine
Background:
- Sleep disturbances are a frequent complaint among pediatric patients diagnosed with inflammatory bowel disease (IBD), persisting even during periods of clinical remission.
- The Pittsburgh Sleep Quality Index (PSQI) is a validated tool for assessing subjective sleep quality in various patient populations.
Purpose of the Study:
- To determine the prevalence of sleep disturbances in pediatric IBD patients.
- To investigate the association between IBD clinical features, disease activity, inflammatory markers, and sleep quality.
- To evaluate the predictive value of disease activity indices for sleep disturbances in pediatric IBD.
Main Methods:
- Retrospective analysis of clinical and demographic data, laboratory parameters, and disease activity from 99 pediatric IBD patients (44 Crohn's disease, 55 Ulcerative Colitis) and 80 healthy controls.
- Administration of the Pittsburgh Sleep Quality Index (PSQI) to all participants.
- Correlation analysis between PSQI scores and clinical/laboratory parameters, including disease activity indices (Pediatric Crohn's Disease Activity Index and Pediatric Ulcerative Colitis Activity Index).
Main Results:
- Pediatric IBD patients exhibited significantly higher PSQI scores compared to healthy controls, indicating poorer sleep quality.
- Patients with IBD, particularly those with Ulcerative Colitis, reported later sleep times and shorter sleep durations than controls.
- Strong positive correlations were observed between disease activity indices, abdominal pain, and PSQI scores in both Crohn's disease and Ulcerative Colitis patients.
- The Pediatric Crohn's Disease Activity Index and Pediatric Ulcerative Colitis Activity Index were identified as independent risk factors for sleep disturbances, demonstrating high sensitivity and specificity.
Conclusions:
- Increased disease activity in pediatric IBD significantly impairs sleep quality.
- The PSQI and specific pediatric disease activity indices (PCDAI, PUCAI) are robust tools for identifying and predicting sleep disorders in pediatric IBD patients.
- These findings underscore the importance of assessing sleep quality in the comprehensive management of pediatric IBD.
Abstract:
The aim of the study was to assess the prevalence of sleep disturbance in pediatric IBD patients and evaluate the relationship between clinical features of IBD, disease activity, inflammatory markers and quality of sleep. A total of 99 patients who were followed-up with the diagnosis of IBD (44 Crohn's disease (CD), 55 Ulcerative colitis (UC)) between 2015-2020 and 80 healthy controls were enrolled in the study. The clinical and demographic characteristics, laboratory parameters and disease activities were obtained from medical reports retrospectively. Pittsburgh sleep quality index (PSQI) was administered to all participants. PSQI score was significantly higher in patient group than the control group (P < 0.001). The sleep time of patient group, especially patients with UC was later than the control group (P = 0.008). Sleep duration was longer in control group than the patient group (P < 0.001). A positive strong correlation was obtained in disease activity index (r = 0.886; P < 0.001) and abdominal pain (r = 0.781; P < 0.001) with PSQI scores of CD patients. Disease activity index, rectal bleeding, diarrhea and number of stool had statistically significant positive strong correlation with PSQI scores of UC patients (P < 0.001). Pediatric Crohn's disease activity index and Pediatric ulcerative colitis activity index were the only independent risk factors affecting sleep disturbances (80% sensitivity and 91.67% specificity, 93.1% sensitivity and %96.15 specificity, respectively). Conclusion: Increased disease activity has adverse effects on sleep quality. PSQI and PCDAI were strong tests for predicting sleep disorders in pediatric patients with IBD. What is Known: • Sleep disturbances are common complaint in inflammatory bowel disease (IBD), even in clinical remission. • Pittsburgh sleep quality index (PSQI) was used to evaluate the subjective sleep quality of patients. What is New: • PSQI and Pediatric Crohn Disease Activity index (PCDAI) were strong tests for predicting sleep disorders in pediatric patients with IBD. • PSQI and PCDAI scores correlated significantly with the severity of the sleep disturbances.
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