Abstract
OBJECTIVE: To examine the association between sleep pattern, which integrates sleep duration, chronotype and quality, with risk of bowel resection and all-cause mortality in patients with inflammatory bowel disease (IBD) based on a long-term prospective cohort.
DESIGN: Prevalent patients with IBD were categorised into poor (0-2 score), intermediate (3 score) and healthy (4-5 score) based on sleep score. The score assigned 1 point for each of five low-risk sleep behaviours: sleep 7-8 hours per day, early chronotype, no snoring, never/rarely insomnia symptoms and no frequent daytime sleepiness. The primary outcome was all-cause death, with bowel resection as a secondary outcome. Multivariable Cox proportional hazards models were used to explore the association.
SETTING: This study used the data from the UK Biobank with participants recruited in 2006-2010.
PARTICIPANTS: Among 502 411 participants recruited in UK biobank, 4262 cancer-free patients with IBD at baseline were finally included.
RESULTS: During a median of 14.6-year follow-up, 793 received bowel resection and 498 deaths developed. Compared with poor sleep pattern, both healthy (HR=0.75, 95% CI 0.59 to 0.94) and intermediate (HR=0.77, 95% CI 0.66 to 0.95) sleep groups had reduced mortality risk, with a dose-response relationship across sleep scores (HR=0.89, 95% CI 0.82 to 0.98). Specifically, appropriate sleep duration (HR=0.79, 95% CI 0.66 to 0.95) and early chronotype (HR=0.82, 95% CI 0.68 to 0.98) were associated with 21% and 18% lower mortality risk, respectively. Marginally significant lower risk of bowel resection was observed with healthy (HR=0.86, 95% CI 0.72 to 1.04) and intermediate (HR=0.87, 95% CI 0.73 to 1.03) sleep pattern, with 22% lower risk associated with never/rarely insomnia symptoms (HR=0.78, 95% CI 0.65 to 0.94).
CONCLUSIONS: A healthy sleep pattern, particularly sleep duration and early chronotype, is associated with reduced all-cause mortality risk in patients with IBD, with probably beneficial effect on lowering risk of bowel resection, highlighting the importance of maintaining healthy sleep behaviours for long-term prognosis in IBD.