Elsenbruch Sigrid, Thompson Jennifer J, Hamish Michael J, Exton Michael S, Orr William C
Lynn Institute for Healthcare Research, Oklahoma City, Oklahoma, USA.
Am J Gastroenterol. 2002 Sep;97(9):2306-14. doi: 10.1111/j.1572-0241.2002.05984.x.
The goal of this study was to investigate behavioral (self-reported) and physiological sleep characteristics in irritable bowel syndrome (IBS) patients with and without concurrent dyspeptic symptoms, as compared to control subjects.
A total of 31 women with IBS were stratified into two groups: 15 with bowel symptoms only (IBS-only) and 16 with both lower and upper dyspeptic symptoms (IBS+D). In addition, 23 healthy women served as controls. For 4 consecutive days, subjective sleep quality, insomnia symptoms, alertness, state anxiety, perceived daytime stress, and daytime and nighttime GI symptoms were assessed. On night 4, subjects underwent polysomnographic (PSG) monitoring for an objective assessment of sleep quality including microarousals and respiratory parameters. Saliva samples were collected for cortisol analyses each morning and evening across the 4 days of the study. Psychological disturbances were assessed with the SCL.
Patients reported significantly more dissatisfaction with their sleep quality and increased daytime fatigue as a result of both insomnia-type symptomatology and nonrestful sleep. These complaints were significantly greater in IBS+D compared to IBS-only for some measures. A significant proportion of patients, particularly IBS+D patients, reported nighttime GI symptoms. Patients reported significantly greater average anxiety across the 4 days, which was greatest in IBS+D. Although both patient subgroups showed normal levels and circadian changes in cortisol compared to controls, IBS+D had significantly increased morning salivary cortisol levels compared to IBS-only. PSG data showed no significant differences between the patient groups and controls. Significant correlations were found between psychological distress and retrospective subjective sleep complaints for patients.
This study confirms the importance of sleep complaints and nighttime GI symptoms in women with IBS that are not substantiated by any objective, physiological evidence. Rather, there is a reporting bias regarding sleep disturbances, which appears to be related to symptom severity and psychological disturbances.
本研究的目的是调查伴有和不伴有消化不良症状的肠易激综合征（IBS）患者的行为（自我报告）和生理睡眠特征，并与对照组进行比较。
总共31名IBS女性被分为两组：15名仅有肠道症状（仅IBS组）和16名同时有上下消化道消化不良症状（IBS+D组）。此外，23名健康女性作为对照。连续4天，评估主观睡眠质量、失眠症状、警觉性、状态焦虑、感知的日间压力以及日间和夜间胃肠道症状。在第4晚，受试者接受多导睡眠图（PSG）监测，以客观评估睡眠质量，包括微觉醒和呼吸参数。在研究的4天中，每天早晚收集唾液样本进行皮质醇分析。使用症状自评量表评估心理障碍。
患者报告称，由于失眠型症状和睡眠不安，他们对睡眠质量的不满明显更多，日间疲劳增加。在某些指标上，IBS+D组的这些抱怨比仅IBS组明显更严重。相当一部分患者，尤其是IBS+D组患者，报告有夜间胃肠道症状。患者报告称在这4天中的平均焦虑明显更高，在IBS+D组中最为严重。尽管与对照组相比，两个患者亚组的皮质醇水平和昼夜变化均正常，但IBS+D组的晨间唾液皮质醇水平比仅IBS组显著升高。PSG数据显示患者组和对照组之间无显著差异。发现患者的心理困扰与回顾性主观睡眠抱怨之间存在显著相关性。
本研究证实了IBS女性中睡眠抱怨和夜间胃肠道症状的重要性，但没有任何客观生理证据支持这些症状。相反，存在关于睡眠障碍的报告偏差，这似乎与症状严重程度和心理困扰有关。
