睡眠通过肠易激综合征成人患者的日间功能障碍对腹痛产生的间接影响。
Indirect effect of sleep on abdominal pain through daytime dysfunction in adults with irritable bowel syndrome.
作者信息
Yang Pei-Lin, Burr Robert L, Buchanan Diana T, Pike Kenneth C, Kamp Kendra J, Heitkemper Margaret M
机构信息
Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington.
Office of Nursing Research, School of Nursing, University of Washington, Seattle, Washington.
出版信息
J Clin Sleep Med. 2020 Oct 15;16(10):1701-1710. doi: 10.5664/jcsm.8658.
STUDY OBJECTIVES
Sleep deficiency, psychological distress, daytime dysfunction, and abdominal pain are common in adults with irritable bowel syndrome. Prior research on individuals with chronic pain has identified the indirect effect of sleep on pain through psychological distress or daytime dysfunction; however, this effect is less clear in irritable bowel syndrome. The purpose of this study was to examine potential indirect effects of sleep on abdominal pain symptoms simultaneously through psychological distress and daytime dysfunction in adults with irritable bowel syndrome.
METHODS
Daily symptoms of nighttime sleep complaints (sleep quality and refreshment), psychological distress, daytime dysfunction (fatigue, sleepiness, and difficulty concentrating), and abdominal pain were collected in baseline assessments from 2 randomized controlled trials of 332 adults (mean age 42 years and 85% female) with irritable bowel syndrome. Structural equation modeling was used to examine the global relationships among nighttime sleep complaints, psychological distress, daytime dysfunction, and abdominal pain.
RESULTS
The structural equation modeling analyses found a strong indirect effect of poor sleep on abdominal pain via daytime dysfunction but not psychological distress. More than 95% of the total effect of nighttime sleep complaints on abdominal pain was indirect.
CONCLUSIONS
These findings suggest that the primary impact of nighttime sleep complaints on abdominal pain is indirect. The indirect effect appears primarily through daytime dysfunction. Such understanding provides a potential avenue to optimize personalized and hybrid behavioral interventions for adults with irritable bowel syndrome through addressing daytime dysfunction and sleep behaviors. Additional study integrating symptoms with biological markers is warranted to explore the underlying mechanisms accounting for these symptoms.
CLINICAL TRIAL REGISTRATION
Registry: ClinicalTrials.gov. Name: Nursing Management of Irritable Bowel Syndrome: Improving Outcomes, Nursing Management of IBS: Improving Outcomes. URLs: https://clinicaltrials.gov/ct2/show/NCT00167635, https://clinicaltrials.gov/ct2/show/NCT00907790. Identifiers: NCT00167635, NCT00907790.
研究目的
睡眠不足、心理困扰、日间功能障碍和腹痛在肠易激综合征成人患者中很常见。先前针对慢性疼痛患者的研究已经确定了睡眠通过心理困扰或日间功能障碍对疼痛产生的间接影响；然而，这种影响在肠易激综合征中尚不清楚。本研究的目的是探讨睡眠对肠易激综合征成人患者腹痛症状的潜在间接影响，这种影响是通过心理困扰和日间功能障碍同时介导的。
方法
在两项针对332名肠易激综合征成人患者（平均年龄42岁，85%为女性）的随机对照试验的基线评估中，收集了夜间睡眠问题（睡眠质量和恢复情况）、心理困扰、日间功能障碍（疲劳、嗜睡和注意力不集中）以及腹痛的每日症状。采用结构方程模型来研究夜间睡眠问题、心理困扰、日间功能障碍和腹痛之间的整体关系。
结果
结构方程模型分析发现，睡眠不佳通过日间功能障碍而非心理困扰对腹痛产生强烈的间接影响。夜间睡眠问题对腹痛的总影响中，超过95%是间接影响。
结论
这些发现表明，夜间睡眠问题对腹痛的主要影响是间接的。这种间接影响主要通过日间功能障碍体现。这样的认识为通过解决日间功能障碍和睡眠行为来优化针对肠易激综合征成人患者的个性化和综合行为干预提供了一条潜在途径。有必要进行更多将症状与生物标志物相结合的研究，以探索这些症状背后的潜在机制。
临床试验注册
注册机构：ClinicalTrials.gov。名称：肠易激综合征的护理管理：改善结局，肠易激综合征的护理管理：改善结局。网址：https://clinicaltrials.gov/ct2/show/NCT00167635，https://clinicaltrials.gov/ct2/show/NCT00907790。标识符：NCT00167635，NCT00907790。
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