Sleep Impairment: A Trigger for Relapse in IBD?

David A. Johnson, MD


January 23, 2014

In This Article

Role of Sleep in IBD Relapse

Is it possible to prevent relapses of IBD?

A very interesting study from the University of North Carolina was recently published in Clinical Gastroenterology and Hepatology.[4] Using the Crohn's and Colitis Foundation of America Partners database, the investigators looked at the likelihood for flares in patients who were "in remission," defined as a Short Crohn's Disease Activity Index < 150 for patients with Crohn disease or a Simple Clinical Colitis Activity Index ≤ 2 for patients with ulcerative colitis.

They evaluated these patients for sleep deprivation, and found that approximately 60% of the patients had sleep disturbances at baseline. Patients in remission who had sleep disturbances were more likely to experience flares of their disease. Compared with patients who had no sleep abnormalities, those with sleep impairment in the population with Crohn disease were twice as likely to experience a flare within 6 months. Patients who were considered to be in remission of their IBD were not in remission with respect to sleep deprivation or sleep abnormality.

Of interest, this didn't apply to patients with ulcerative colitis, but these phenotypes of IBD are different. For example, smoking affects Crohn disease negatively, but it affects ulcerative colitis positively. So there are some variances of effect for these diseases. I am not ready to say that sleep deprivation has no effect on patients with ulcerative colitis, because physiologically, it makes too much sense that it would.

A study[5] was done in which animals were given melatonin to restore their sleep patterns, making these animals more resistant to drug-induced colitis. It makes sense to some degree that melatonin would have a physiologic effect, because it is normally secreted by the pineal gland. Melatonin is also a powerful antioxidant and free-radical scavenger that reduces TNF-alpha secretion. Therefore, it makes sense that it may have a beneficial role in patients with IBD. I have liberalized my use of melatonin in patients with IBD in a proactive way to prevent a relapse or an active flare of disease.

To summarize, IBD is associated with an upregulation of cytokines. Sleep deprivation or sleep abnormalities also upregulate cytokines. You can see a self-perpetuating vicious cycle here: As disease flares, patients sleep poorly. They take medications that make them sleep more poorly, and cytokines upregulate further.


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