Association between sleep quality and disease activity in inflammatory bowel disease: A systematic review and...

The purpose of this review was to examine evidence on the association between poor sleep quality and disease activity in inflammatory bowel disease (IBD).

PubMed, Embase, Scopus, and the Web of Science were searched till July 15, 2025, for studies reporting an association between sleep quality and IBD. Outcomes were pooled as odds ratio (OR) in a random-effects meta-analysis model.

Twenty studies were included. Most studies were cross-sectional. The majority used the Pittsburgh Sleep Questionnaire Index for assessing sleep quality. Meta-analysis showed that poor sleep quality was significantly associated with active disease in IBD (OR: 2.54 95% CI: 1.85, 3.49 I²=80%). Subgroup analysis showed a significant association between poor sleep quality and active disease in CD, but not in UC. In subgroup analyses based on study design, results were significant only in cross-sectional studies, not in cohort studies. Meta-regression analysis using the moderators: sample size, age, males, body mass index, disease duration, prevalence of active disease and poor sleep quality, IBD surgery, and Newcastle-Ottawa scale score did not show significant results.

Low-quality evidence, mostly from cross-sectional data, suggests an association between poor sleep quality and active disease in IBD. However, the findings were not replicated by prospective cohort studies. Given the predominance of cross-sectional data, the possibility of reverse causation, whereby active disease itself leads to impaired sleep quality, cannot be excluded. Further robust studies are needed to support these findings.