Intest Res.  2024 Jan;22(1):104-114. 10.5217/ir.2023.00028.

Insomnia is common in inflammatory bowel disease (IBD) and is associated with mental health conditions as well as IBD activity

• Barnes A
• Andrews JM
• Mukherjee S
• Bryant RV
• Bampton P
• Fraser RJ
• Mountifield R

• KMID: 2551283
• DOI: http://doi.org/10.5217/ir.2023.00028

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.

Keyword

Inflammatory bowel disease; Sleep initiation and maintenance disorders; Analgesics, opioid; Quality of life

Figure

• 

  Fig. 1. Simple Clinical Colitis Activity Index score component values and mean Insomnia Severity Index scores, with standard deviation as error bars. General well-being score varies from 0: very well, 1: slightly below par, 2: poor, 3: very poor, 4: terrible. Blood score varies from 0: none, 1: trace, 2: occasionally frank, 3: usually frank. Urgency score varies from 0: no urgency, 1: hurry, 2: immediately, 3: incontinence. Nocturnal bowel motions score varies from 0: 1–3 times, 1: 4–6 times. Daytime bowel motions score varies from 0: 1–3 times, 1: 4–6 times, 2: 7–9 times, 3: >9 times. The extracolonic features score is the number of active extracolonic features.

• 

  Fig. 2. Harvey Bradshaw Index score component values and mean Insomnia Severity Index scores, with standard deviation as error bars. General well-being score varies from 0: very well, 1: slightly below par, 2: poor, 3: very poor, 4: terrible. Liquid stool per day score varies from 0: none, 1: once, 2: twice, 3: three or more liquid bowel actions a day. Abdominal pain score varies from 0: none, 1: mild, 2: moderate, 3: severe. The extraintestinal features score is the number of active extracolonic features.

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