免疫调节剂和生物制剂对炎症性肠病患者睡眠质量的影响。
Immunomodulator and Biologic Agent Effects on Sleep Quality in Patients With Inflammatory Bowel Disease.
作者信息
Lee Ann Joo, Kraemer Dale F, Kanar Ozdemir, Berry Andrew C, Smotherman Carmen, Eid Emely
机构信息
Department of Gastroenterology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL.
Department of Neurology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL.
出版信息
Ochsner J. 2018 Spring;18(1):76-80.
BACKGROUND
Inflammatory bowel disease (IBD) can disrupt normal sleep physiology and amplify a negative perception about quality of life. Evidence suggests increased circulation of inflammatory cytokines, such as tumor necrosis factor-alpha and interleukin-1, may play a role.
METHODS
A total of 56 patients completed the Pittsburgh Sleep Quality Index (PSQI) to measure 7 sleep domains: sleep quality, sleep latency, sleep duration, sleep efficacy, sleep disturbance, sleep medications, and daytime dysfunction. Domain scores were summed to determine the presence or absence of sleep impairment. We compared patients taking immunomodulators or biologic agents to patients not on immunomodulator or biologic agent therapy. Demographics and IBD-related clinical information were collected to adjust for potential confounders that may secondarily affect sleep, such as body mass index, depression/anxiety, and sleep-affecting medications.
RESULTS
The majority of patients with IBD (46 [82%]) reported poor sleep quality; 22 (79%) of the patients taking immunomodulators or biologic agents and 24 (86%) of the patients not on these therapies had a global PSQI score ≥5, suggestive of poor sleep quality. However, we found no significant difference between the 2 groups. When we analyzed the 7 PSQI sleep domains individually, we found improved sleep duration in the group taking immunomodulators or biologic agents compared to the group not on therapy, although the difference was not statistically significant.
CONCLUSION
The majority of patients with IBD experience some degree of sleep impairment, and treatment with immunomodulators and biologic agents does not appear to improve sleep quality. A multicenter study with a larger sample size is warranted to better assess the diverse population of patients with IBD and the factors that impact their sleep. Routine assessment of sleep quality during IBD clinical encounters is recommended.
背景
炎症性肠病（IBD）可扰乱正常睡眠生理，并加剧对生活质量的负面认知。有证据表明，炎症细胞因子如肿瘤坏死因子-α和白细胞介素-1的循环增加可能起了一定作用。
方法
共有56名患者完成了匹兹堡睡眠质量指数（PSQI），以测量7个睡眠领域：睡眠质量、入睡潜伏期、睡眠时间、睡眠效率、睡眠障碍、睡眠药物使用情况和日间功能障碍。将各领域得分相加，以确定是否存在睡眠障碍。我们将服用免疫调节剂或生物制剂的患者与未接受免疫调节剂或生物制剂治疗的患者进行了比较。收集了人口统计学和IBD相关的临床信息，以调整可能继发影响睡眠的潜在混杂因素，如体重指数、抑郁/焦虑和影响睡眠的药物。
结果
大多数IBD患者（46例[82%]）报告睡眠质量差；服用免疫调节剂或生物制剂的患者中有22例（79%），未接受这些治疗的患者中有24例（86%）的PSQI总评分≥5，提示睡眠质量差。然而，我们发现两组之间没有显著差异。当我们分别分析PSQI的7个睡眠领域时，我们发现服用免疫调节剂或生物制剂的组与未接受治疗的组相比，睡眠时间有所改善，尽管差异无统计学意义。
结论
大多数IBD患者存在一定程度的睡眠障碍，免疫调节剂和生物制剂治疗似乎并未改善睡眠质量。有必要进行一项样本量更大的多中心研究，以更好地评估IBD患者的多样化群体以及影响他们睡眠的因素。建议在IBD临床诊疗过程中对睡眠质量进行常规评估。
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