Anxiety and Depression are Key Factors Affecting Sleep Quality in Patients With Inflammatory Bowel Disease, Independent of Disease Activity
Background:
Anxiety, depression, and poor sleep quality (PSQ) are more prevalent in patients with inflammatory bowel disease (IBD) than in the general population and associated with increased risk of morbidity, mortality and decreased health-related quality of life. PSQ is also known to exacerbate inflammation. However, the extent and directionality of the relationship between mental health, sleep quality, and IBD activity are unclear.
Methods:
A retrospective cohort study was performed to assess the correlation of mental health, sleep quality, and disease activity for patients with Crohn’s disease (CD) and ulcerative colitis (UC) treated at our IBD Center between October 2023 and August 2024. Patients were screened using the Generalized Anxiety Disorder 7 (GAD-7), Patient Health Questionnaire 9 (PHQ-9), and Pittsburgh Sleep Quality Index (PSQI). Poor sleep quality (PSQ) was defined as global PSQI > 5 (possible scores 0-21). IBD activity was measured using the Harvey-Bradshaw Index (HBI) or Simplified Clinical Colitis Activity Index (SCCAI). Patient demographics, disease characteristics, inflammatory biomarkers, and history of sleep disorders were observed.
Results:
A total of 143 patients were included in our cohort (96 Crohn’s, 86 women, 127 White). Median age was 48 years (IQR: 37-60.3) for CD and 47 years (IQR: 33-61) for UC. We identified 42 patients with anxiety (27 mild, 8 moderate, 7 severe) and 52 patients with depression (33 mild, 16 moderate, 2 moderately severe, 1 severe). 10 patients with CD and 8 patients with UC had clinically active disease (HBI≥5, SCCAI≥3); of 37 patients with CD and 14 patients with UC who had CRP measured, 14 and 6 had elevated CRP (>3.0 mg/L) within 90 days of screening, respectively. Of the entire cohort, 80 patients (54 CD, 26 UC) reported PSQ. Chi-Square Test of Independence demonstrated that PSQ was significantly associated with anxiety (<italic>P<</italic> 0.0001) and depression (<italic>P<</italic> 0.0001) in all patients. PSQ was not significantly correlated with binary clinical disease activity (p=0.808) or elevated CRP (p=0.125). Of the 80 patients reporting PSQ, 52 (65%) had no history of sleep disorders. Of the 35 patients with known sleep disorders (majority OSA and insomnia), 26 (74.3%) reported PSQ.
Conclusions:
This study confirms the high prevalence of mental health disturbances and PSQ among patients with IBD. PSQ is especially common among patients with comorbid anxiety and depression, regardless of clinical or biochemical disease activity. We propose ongoing efforts to screen and treat patients with IBD for mental health disorders and sleep disorders. Future research must also explore how the treatment of mental health symptoms in the IBD space may improve sleep quality and clinical disease activity.
