1
|
Zhang JZ, Song XZ, Song XN, Shen YL, Tang H, Li H. Prevalence and risk factors of sleep disorders in inflammatory bowel disease: a cross-sectional study. Int J Colorectal Dis 2024; 39:140. [PMID: 39266810 PMCID: PMC11393029 DOI: 10.1007/s00384-024-04712-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2024] [Indexed: 09/14/2024]
Abstract
BACKGROUND Sleep disorders are one of the major public health problems, which can potentially induce inflammation and exacerbate disease activity, resulting in compromised sleep quality. This study aimed to investigate the prevalence and risk factors associated with sleep disorders among patients with inflammatory bowel disease (IBD). METHODS Between March 2023 and February 2024, the Pittsburgh Sleep Quality Index was employed to assess sleep quality in both IBD patients and healthy control subjects. Univariate and multivariate analysis were performed to identify the risk factors associated with SD in IBD patients. RESULTS Overall, 208 IBD patients [150 Crohn's disease (CD) and 58 ulcerative colitis (UC)] and 199 healthy individuals were included. Sleep disorders were observed in 59.6% of patients with IBD, with a higher prevalence among females (63.5%) compared to males (56.9%) (P = 0.476). The prevalence of sleep disorders in IBD patients was significantly higher than that found in healthy controls (37.7%) (all P < 0.01). The prevalence of sleep disorders among CD and UC patients was 58% and 63.8%, respectively (P = 0.291). The multivariate analysis revealed that older age (OR, 1.070; 95% CI: 1.035-1.105, P = 0.000), smoking (OR, 2.698; 95% CI: 1.089-6.685, P = 0.032), and depression (OR, 4.779; 95% CI: 1.915-11.928, P = 0.001) were risk factors for sleep disorders in IBD patients. However, higher body mass index (OR, 0.879; 95% CI: 0.790-0.977, P = 0.017) was identified as a protective factor. CONCLUSION Sleep disorders are common among IBD patients regardless of activity levels. Smoking and depression are the major risk factors.
Collapse
Affiliation(s)
- Jin-Zhi Zhang
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Infectious and Liver Diseases, Institute of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China
| | - Xiao-Zhen Song
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Xiao-Na Song
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Infectious and Liver Diseases, Institute of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China
| | - Ya-Lin Shen
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Infectious and Liver Diseases, Institute of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China
| | - Hong Tang
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.
- Laboratory of Infectious and Liver Diseases, Institute of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.
| | - Hong Li
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.
- Laboratory of Infectious and Liver Diseases, Institute of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.
| |
Collapse
|
2
|
Barnes A, Bryant RV, Mukherjee S, Spizzo P, Mountifield R. Sleep quality is associated with reduced quality of life in inflammatory bowel disease through its interaction with pain. JGH Open 2024; 8:e70021. [PMID: 39185482 PMCID: PMC11344164 DOI: 10.1002/jgh3.70021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 07/07/2024] [Accepted: 08/07/2024] [Indexed: 08/27/2024]
Abstract
Background and Aim Quality of life is reduced in people with inflammatory bowel disease (IBD) and poor sleep is prevalent in people with IBD. This study aimed to investigate the influence of sleep on quality of life (QoL) in people with inflammatory bowel disease. Methods An online questionnaire was administered through three tertiary IBD centers, social media, and through Crohn's Colitis Australia. The questionnaire included the EQ-5D-5L measures of health-related QoL, the Insomnia Severity Index, the Pittsburgh Sleep Quality Index (PSQI), and validated IBD activity and mental health scores. Results There were 553 responses included with a diagnosis of Crohn's disease (62.2%), with over half on biologic therapy (53.1%). Poor sleep and clinically significant insomnia were associated with lower QoL (EQ-5D-5L scores: EQVAS, utility score, P < 0.001 for all). Sleep quality scores correlated with the EQ-5D-5L domains of "pain" (ρ 0.35, P < 0.001), "usual activities" (ρ 0.32, P < 0.001), and "depression-anxiety" (ρ 0.37, P < 0.001). After adjusting for demographic variables, IBD activity, and depression and anxiety via multivariate regression, the "pain" domain continued to be associated with PSQI components "sleep quality" (P < 0.001), "sleep disturbance" (P < 0.001), and "sleep duration" (P < 0.001). Clinically significant insomnia was associated with a reduction in QoL (EQVAS, utility score) independent of IBD activity (P < 0.001) and of a similar magnitude to that seen with IBD activity. Conclusion Health-related QoL in IBD is influenced by aspects of sleep quality irrespective of IBD activity and mental health conditions. The presence of insomnia is associated with a reduction in health-related QoL. Consideration should be given to sleep targeting interventional studies in an IBD population.
Collapse
Affiliation(s)
- Alex Barnes
- Department of GastroenterologySouthern Adelaide Local Health Network (SALHN) Flinders Medical CentreBedford ParkSouth AustraliaAustralia
- College of Medicine and Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Robert V Bryant
- School of Medicine, Faculty of Health and Medical SciencesUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Department of GastroenterologyQueen Elizabeth HospitalWoodvilleSouth AustraliaAustralia
| | - Sutapa Mukherjee
- Adelaide Institute for Sleep Health, Flinders Health and Medical Research InstituteCollege of Medicine and Public Health, Flinders UniversityBedford ParkSouth AustraliaAustralia
- Department of Respiratory and Sleep MedicineSouthern Adelaide Local Health Network (SALHN) Flinders Medical CentreBedford ParkSouth AustraliaAustralia
| | - Paul Spizzo
- Department of GastroenterologySouthern Adelaide Local Health Network (SALHN) Flinders Medical CentreBedford ParkSouth AustraliaAustralia
| | - Réme Mountifield
- Department of GastroenterologySouthern Adelaide Local Health Network (SALHN) Flinders Medical CentreBedford ParkSouth AustraliaAustralia
- College of Medicine and Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
| |
Collapse
|
3
|
Jian S, Liu J, He M, Liu B, Liu K, Zang C, Su X, Zhang Y, Yi M. Crosstalk between gastrointestinal tract disorders and obstructive sleep apnea. Sleep Breath 2024:10.1007/s11325-024-03082-5. [PMID: 39031245 DOI: 10.1007/s11325-024-03082-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 06/05/2024] [Accepted: 06/10/2024] [Indexed: 07/22/2024]
Abstract
PURPOSE Clinical studies suggested associations between obstructive sleep apnea (OSA) and gastrointestinal tract disorders. This study aims to investigate the genetic causal relationship between OSA and gastrointestinal tract disorders, specifically gastroesophageal reflux disease (GERD) and inflammatory bowel disease (IBD). METHODS In this study, we employed two-sample Mendelian Randomization (MR) analysis to investigate the potential relationships between OSA and GERD, and between OSA and IBD. More specifically, the primary analysis utilized inverse variance weighting (IVW). Weighted median, MR Egger, and MR PRESSO were applied to complicate potential violations of MR assumptions. Also, sensitivity analysis was evaluated and similar analysis was performed again after outliers were removed. Additionally, multivariable MR (MVMR) was conducted for associated pairs to adjust for obesity. RESULTS Genetically predicted risk of GERD increased OSA risk by approximately 60% (ORIVW = 1.62, 95%CI = [1.43,1.84]) which was also stable by other complicated approaches, and even with BMI adjusted by MVMR (ORadjBMI[95%CI] = 1.26 [1.15,1.37]). Besides, OSA showed a mild causal effect on increased GERD risk after adjusting for obesity (ORadjBMI[95%CI] = 1.05 [1.02,1.08]). Additionally, OSA increased the risks for IBD (ORIVW[95%CI] = 1.36 [1.12,1.65]), including a higher risk of CD (ORIVW[95%CI] = 1.41 [1.08,1.83]), and a trend for increasing UC risk (ORIVW[95%CI] = 1.29 [0.99,1.67]). CONCLUSION GERD exerts a substantial causality on increasing the risk of OSA. Conversely, the potential for a causal relationship that OSA contributes to the development of GERD or IBD remains probable. These findings support the crosstalk between gastrointestinal tract disorders and OSA.
Collapse
Affiliation(s)
- Shijie Jian
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- School of Life Sciences, Central South University, Changsha, China
| | - Jie Liu
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Xiangya Medical School, Central South University, Changsha, China
| | - Meng He
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Bin Liu
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Kun Liu
- School of Life Sciences, Central South University, Changsha, China
| | - Chenyang Zang
- Xiangya Medical School, Central South University, Changsha, China
| | - Xiaoli Su
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
| | - Yuan Zhang
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
| | - Minhan Yi
- School of Life Sciences, Central South University, Changsha, China.
| |
Collapse
|
4
|
Dai L, Ye Y, Mugaanyi J, Lu C, Lu C. Impact of insomnia upon inflammatory digestive diseases and biomarkers: a two-sample mendelian randomization research on Europeans. BMC Gastroenterol 2024; 24:79. [PMID: 38383296 PMCID: PMC10880338 DOI: 10.1186/s12876-024-03173-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 02/13/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND A number of observational studies indicate that insomnia is linked to inflammatory digestive diseases (IDDs). However, the definite relationship between insomnia and IDDs remains unclear. METHODS We obtained the publicly available data from genome-wide association studies (GWAS) to conduct two-sample Mendelian randomization (MR) for association assessment. Five MR analysis methods were used to calculate the odds ratio (OR) and effect estimate, and the heterogeneity and pleiotropy tests were performed to evaluate the robustness of the variable instruments (IVs). RESULTS One exposure and twenty outcome datasets based on European populations were included in this study. Using the inverse variance weighted method, we found insomnia was closely correlated with esophageal ulcer (OR = 1.011, 95%CI = 1.004-1.017, p = 0.001) and abdominal pain (effect estimate = 1.016, 95%CI = 1.005-1.026, p = 0.003). Suggestive evidence of a positively association was observed between insomnia and duodenal ulcer (OR = 1.006, 95%CI = 1.002-1.011, p = 0.009), gastric ulcer (OR = 1.008, 95%CI = 1.001-1.014, p = 0.013), rectal polyp (OR = 1.005, 95%CI = 1.000-1.010, p = 0.034), haemorrhoidal disease (OR = 1.242, 95%CI = 1.004-1.535, p = 0.045) and monocyte percentage (effect estimate = 1.151, 95%CI = 1.028-1.288, p = 0.014). No correlations were observed among other IDDs, phenotypes and biomarkers. CONCLUSIONS Our MR study assessed the relationship between insomnia and IDDs/phenotypes/biomarkers in depth and revealed potential associations between insomnia and ulcers of the esophagus and abdominal pain.
Collapse
Affiliation(s)
- Lei Dai
- Department of Hepato-Pancreato-Biliary Surgery, Health Science Center, Ningbo Medical Centre Lihuili Hospital, Ningbo University, 1111 Jiangnan Road, Ningbo, 315040, Zhejiang, China
| | - Yunyan Ye
- Department of Ophthalmology, Health Science Center, Ningbo Medical Centre Lihuili Hospital, Ningbo University, Ningbo, 315040, Zhejiang, China
| | - Joseph Mugaanyi
- Department of Hepato-Pancreato-Biliary Surgery, Health Science Center, Ningbo Medical Centre Lihuili Hospital, Ningbo University, 1111 Jiangnan Road, Ningbo, 315040, Zhejiang, China
| | - Caide Lu
- Department of Hepato-Pancreato-Biliary Surgery, Health Science Center, Ningbo Medical Centre Lihuili Hospital, Ningbo University, 1111 Jiangnan Road, Ningbo, 315040, Zhejiang, China.
| | - Changjiang Lu
- Department of Hepato-Pancreato-Biliary Surgery, Health Science Center, Ningbo Medical Centre Lihuili Hospital, Ningbo University, 1111 Jiangnan Road, Ningbo, 315040, Zhejiang, China.
| |
Collapse
|
5
|
Barnes A, Andrews JM, Mukherjee S, Bryant RV, Bampton P, Fraser RJ, Mountifield R. Insomnia is common in inflammatory bowel disease (IBD) and is associated with mental health conditions as well as IBD activity. Intest Res 2024; 22:104-114. [PMID: 37904322 PMCID: PMC10850702 DOI: 10.5217/ir.2023.00028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/20/2023] [Accepted: 08/22/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND/AIMS Insomnia is common in people with chronic medical conditions, such as inflammatory bowel disease (IBD), and is readily treatable through cognitive behavioral therapy for insomnia. This study aimed to describe the associations with insomnia in people with IBD and its relationship to IBD-related disability. METHODS An online questionnaire was administered through 3 tertiary IBD centers, social media, and Crohn's Colitis Australia. The questionnaire included the Insomnia Severity Index (ISI), a validated assessment of insomnia. Measures of anxiety, depression, physical activity, and disability were also included. IBD activity was assessed using validated patient reported scores. A multivariate model was constructed for clinically significant insomnia and ISI scores. Subpopulations of Crohn's disease and ulcerative colitis were considered. RESULTS In a cohort of 670 respondents the median age was 41 years (range, 32-70 years), with the majority female (78.4%), the majority had Crohn's disease (57.3%). Increasingly severe disability was associated with worse insomnia score. Clinically significant insomnia was associated with clinically active IBD, abdominal pain, anxiety, and depression, in a multivariate model. In an ulcerative colitis population, Simple Clinical Colitis Activity Index components of general well-being and urgency were associated with worse ISI score in a model including depression and anxiety. In those with Crohn's disease, the multivariate model included Harvey Bradshaw Index score in addition to depression and anxiety. CONCLUSIONS Insomnia is common in people with IBD and is associated with increased disability. Abdominal pain and mental health conditions should prompt consideration for screening for insomnia and referral for cognitive behavioral therapy for insomnia.
Collapse
Affiliation(s)
- Alex Barnes
- Department of Gastroenterology, Southern Adelaide Local Health Network (SALHN) Flinders Medical Centre, Bedford Park, Australia
- Adelaide Institute for Sleep Health, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Jane M Andrews
- Inflammatory Bowel Disease Service, Department of Gastroenterology and Hepatology, Central Adelaide Local Health Network (CALHN) Royal Adelaide Hospital, Adelaide, Australia
- School of Medicine, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Sutapa Mukherjee
- Adelaide Institute for Sleep Health, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
- Department of Respiratory and Sleep Medicine, Southern Adelaide Local Health Network (SALHN) Flinders Medical Centre, Bedford Park, Australia
| | - Robert V Bryant
- School of Medicine, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, Australia
- Department of Gastroenterology, Queen Elizabeth Hospital, Woodville, Australia
| | - Peter Bampton
- Adelaide Institute for Sleep Health, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Robert J. Fraser
- Department of Gastroenterology, Southern Adelaide Local Health Network (SALHN) Flinders Medical Centre, Bedford Park, Australia
- Adelaide Institute for Sleep Health, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Réme Mountifield
- Department of Gastroenterology, Southern Adelaide Local Health Network (SALHN) Flinders Medical Centre, Bedford Park, Australia
- Adelaide Institute for Sleep Health, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| |
Collapse
|
6
|
Salwen-Deremer JK, Reid MJ, Westvold SJ, Siegel CA, Smith MT. People with IBD evidence more microarousals during sleep architecture assessments. BMJ Open Gastroenterol 2023; 10:e001249. [PMID: 38154825 PMCID: PMC10759128 DOI: 10.1136/bmjgast-2023-001249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/29/2023] [Indexed: 12/30/2023] Open
Abstract
OBJECTIVE Poor sleep is common in inflammatory bowel disease (IBD) and may be associated with overall worse disease outcomes. While the sleep/IBD literature is growing, the data are often self-reported. Further, much of the research using objective measures of sleep architecture, or the overall pattern of sleep depth, rely on single-night assessments, which can be of questionable validity. DESIGN Participants with IBD and healthy controls were recruited from Dartmouth-Hitchcock Medical Center as part of a two-phase clinical trial. Sleep architecture was assessed using three nights of in-home electroencephalographic monitoring and scored according to the American Academy of Sleep Medicine guidelines. RESULTS Our sample included 15 participants with IBD and 8 healthy controls. Participants with IBD were more psychiatrically complex, with more self-reported insomnia, anxiety and depression. Participants with IBD evidenced greater microarousals than healthy controls. In participants with IBD, microarousals were associated with lower insomnia and greater depression scores. Within IBD, participants with clinically significant insomnia evidenced trend towards lower sleep efficiency, while self-reported disease activity did not significantly impact findings. CONCLUSIONS The methodology of past research may have impacted findings, including the reliance on single-night assessments and limited generalisability. Future research that uses robust, multinight assessments of sleep architecture in large, diverse samples is clearly warranted, as is research exploring the impact of cognitive and behavioural factors on sleep architecture and arousal. TRIAL REGISTRATION NUMBER NCT04132024.
Collapse
Affiliation(s)
- Jessica K Salwen-Deremer
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Center for Digestive Health, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Matthew J Reid
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Sarah J Westvold
- Center for Digestive Health, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Corey A Siegel
- Center for Digestive Health, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Michael T Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
7
|
Salwen-Deremer JK, Godzik CM, Jagielski CH, Siegel CA, Smith MT. Patients with IBD Want to Talk About Sleep and Treatments for Insomnia with Their Gastroenterologist. Dig Dis Sci 2023; 68:2291-2302. [PMID: 36840812 PMCID: PMC9958321 DOI: 10.1007/s10620-023-07883-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/15/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND AND AIMS Poor sleep may be prospectively associated with worse disease course in inflammatory bowel disease (IBD). Chronic insomnia is the most common cause of poor sleep complaints in IBD and is theorized to be maintained by dysfunctional thoughts and behavioral patterns. However, data characterizing patterns specific to insomnia in IBD are lacking. Understanding the nuances of insomnia and patients' preferences for treatment is critical for addressing this significant comorbidity in IBD. METHODS We conducted an anonymous, mixed-method online survey of people with IBD and asked questions about sleep patterns, thoughts, and behaviors related to sleep, treatment preferences, and barriers to treatment. RESULTS 312 participants (60.9% Crohn's, 66.3% women, mean age of 48.62 years) were included in this study. Participants with insomnia were significantly more concerned about the consequences of sleep loss, felt more helpless about their sleep, and were more likely to engage in behaviors known to perpetuate insomnia (e.g., spending time in bed in pain; ps ≤ 0.001) than those without insomnia. 70.3% of participants were interested in discussing sleep as part of IBD care, 63.5% were interested in receiving sleep recommendations from their gastroenterologist, and 84.6% of those with insomnia were interested in participating in sleep treatments. CONCLUSION Participants with IBD and insomnia are interested in treatment and reported patterns that can be targeted in Cognitive Behavioral Therapy for Insomnia, as opposed to traditional sleep hygiene guidelines. Additionally, people with insomnia engaged in several sleep-interfering behaviors related to pain. Clinical trials that target insomnia in people with IBD should include pain management in the intervention.
Collapse
Affiliation(s)
- Jessica K. Salwen-Deremer
- Departments of Psychiatry & Medicine, Section of Gastroenterology & Hepatology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH USA
| | - Cassandra M. Godzik
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH USA
| | | | - Corey A. Siegel
- Department of Medicine, Section of Gastroenterology & Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH USA
| | - Michael T. Smith
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD USA
| |
Collapse
|
8
|
Sochal M, Ditmer M, Gabryelska A, Białasiewicz P. The Role of Brain-Derived Neurotrophic Factor in Immune-Related Diseases: A Narrative Review. J Clin Med 2022; 11:6023. [PMID: 36294343 PMCID: PMC9604720 DOI: 10.3390/jcm11206023] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/05/2022] [Accepted: 10/10/2022] [Indexed: 07/26/2023] Open
Abstract
Brain-derived neurotrophic factor (BDNF) is a neurotrophin regulating synaptic plasticity, neuronal excitability, and nociception. It seems to be one of the key molecules in interactions between the central nervous system and immune-related diseases, i.e., diseases with an inflammatory background of unknown etiology, such as inflammatory bowel diseases or rheumatoid arthritis. Studies show that BDNF levels might change in the tissues and serum of patients during the course of these conditions, e.g., affecting cell survival and modulating pain severity and signaling pathways involving different neurotransmitters. Immune-related conditions often feature psychiatric comorbidities, such as sleep disorders (e.g., insomnia) and symptoms of depression/anxiety; BDNF may be related as well to them as it seems to exert an influence on sleep structure; studies also show that patients with psychiatric disorders have decreased BDNF levels, which increase after treatment. BDNF also has a vital role in nociception, particularly in chronic pain, hyperalgesia, and allodynia, participating in the formation of central hypersensitization. In this review, we summarize the current knowledge on BDNF's function in immune-related diseases, sleep, and pain. We also discuss how BDNF is affected by treatment and what consequences these changes might have beyond the nervous system.
Collapse
|
9
|
Salwen-Deremer JK, Ballou S. Painful GI Conditions and Their Bidirectional Relationships with Sleep Disturbances. CURRENT SLEEP MEDICINE REPORTS 2022. [DOI: 10.1007/s40675-022-00230-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
10
|
Falling CL, Siegel CA, Salwen-Deremer JK. Inflammatory Bowel Disease and Pain Interference: A Conceptual Model for the Role of Insomnia, Fatigue, and Pain Catastrophizing. CROHN'S & COLITIS 360 2022; 4:otac028. [PMID: 36777421 PMCID: PMC9802206 DOI: 10.1093/crocol/otac028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Indexed: 11/12/2022] Open
Abstract
Background People with inflammatory bowel disease (IBD) commonly experience pain influenced by complex interactions among factors, including disease activity, sleep, psychopathology, and changes in pain processing pathways. Treatments for pain in IBD are limited, highlighting the need for research that explores modifiable factors linked to pain. The aim of this study was to investigate relationships among multiple patient factors and to construct a conceptual model for pain interference in IBD. Methods A cross-sectional survey of adults with IBD. Study domains included demographic, comorbidity, psychological, IBD, insomnia, fatigue, and pain features. Structural equation modeling (SEM) was used to examine relationships and interactions among active IBD, insomnia, fatigue, pain experiences (severity, catastrophizing, and interference), and additional patient factors (demographics and psychological). Results One hundred and seventy-four participants, aged 18-85 years, reported the presence of pain. Combining the questionnaire data using SEM resulted in a final model with an excellent fit (χ 2(8) = 9.579, P = .297, χ 2/N = 1.197, CFIN = 0.997, TLI = 0.987, RMSEA = 0.034). The presence of anxiety and depression was the additional patient factors to be retained in the path analysis. SEM results indicated that greater pain interference was directly influenced by greater fatigue, worse pain catastrophizing, and worse pain severity. Pain interference was indirectly impacted by IBD activity, worse insomnia, and the presence of depression and anxiety. Conclusions The proposed conceptual model highlights the role of multiple potentially modifiable factors, including insomnia, pain catastrophizing, and fatigue, contributing to worse pain interference in people with IBD.
Collapse
Affiliation(s)
- Carrie L Falling
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Corey A Siegel
- Department of Medicine, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Jessica K Salwen-Deremer
- Department of Medicine and Psychiatry, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| |
Collapse
|
11
|
Salwen-Deremer JK, Smith MT, Aschbrenner KA, Haskell HG, Speed BC, Siegel CA. A pilot feasibility trial of cognitive-behavioural therapy for insomnia in people with inflammatory bowel disease. BMJ Open Gastroenterol 2021; 8:e000805. [PMID: 34969664 PMCID: PMC8719151 DOI: 10.1136/bmjgast-2021-000805] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/13/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Poor sleep is common in inflammatory bowel disease (IBD), associated with worse overall disease course and predominantly attributable to insomnia. While cognitive-behavioural therapy for insomnia (CBT-I) is the recommended first-line treatment for chronic insomnia, it is untested in IBD. It is unclear if CBT-I will be as effective in this group given the extent of night-time symptoms people with IBD experience. Thus, we evaluated the feasibility and preliminary efficacy of CBT-I in IBD. DESIGN We comprehensively assessed sleep in people with mild-to-moderately active IBD using questionnaires, daily diaries and actigraphy. People with significant insomnia symptoms were allocated to a single-arm, uncontrolled pilot feasibility study of gold-standard CBT-I treatment. They were then reassessed post-treatment. RESULTS 20 participants with IBD completed a baseline assessment. 10 were experiencing insomnia and were allocated to CBT-I. All participants who were offered CBT-I elected to complete it, and all completed 5/5 sessions. Participants rated treatment acceptability highly and daily diary and actigraphy completion rates were >95%. At baseline, participants with insomnia evidenced significantly worse sleep than participants without insomnia. Following CBT-I, participants reported significant improvements in diary and actigraphy measures of sleep continuity, dysfunctional sleep-related beliefs and IBD disease activity. CONCLUSION CBT-I was feasible and acceptable and demonstrated a signal for efficacy in the treatment of insomnia in IBD. Importantly, the improvements in sleep continuity were consistent with the extant literature. Future fully powered randomised controlled studies should evaluate whether treatment of insomnia can improve other aspects of IBD, including pain and inflammation. TRIAL REGISTRATION NUMBER NCT04132024.
Collapse
Affiliation(s)
- Jessica K Salwen-Deremer
- Department of Medicine, Section of Gastroenterology & Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Michael T Smith
- Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelly A Aschbrenner
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Hannah G Haskell
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Brittany C Speed
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Corey A Siegel
- Department of Medicine, Section of Gastroenterology & Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| |
Collapse
|