Introduction
The management of inflammatory bowel disease (IBD) has traditionally focused on controlling symptoms and reducing or even clearing inflammatory burden. However, the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE)-II statements have expanded the targets to include health-related quality of life (HRQoL) as a long-term outcome. Despite this, the predictive factors for worse HRQoL have yet to be fully completely determined. Alongside psychosocial status, it has been hypothesized that illness perception may also influence HRQoL. Additionally, a bidirectional relationship between sleep quality and IBD has been observed.
Aims & Methods
We thus aim to investigate the potential association between self-reported sleep quality and HRQoL in patients with IBD and to identify other predictors of HRQoL to so that these factors can be integrated into the evaluation of IBD patients. We conducted a prospective single-center cohort study at a tertiary center. From January 2024 to March 2024, patients previously diagnosed with IBD were invited to complete a comprehensive questionnaire assessing HRQoL using the Short Inflammatory Bowel Disease Questionnaire (SIBDQ), self-reported sleep quality using the Pittsburgh Sleep Quality Index (PSQI), and illness perception using the revised version of the Illness Perception Questionnaire. Demographic, clinical (including history of psychopathology), and symptomatology (evaluated using the Harvey Bradshaw Index (HBI) and Partial Mayo Score), as well as analytical parameters (fecal calprotectin), were assessed at the time of questionnaire completion. Clinical remission was defined as HBI<=3 or Partial Mayo Score<=1. Poor HRQoL was defined as SIBDQ<50 and poor sleep quality defined as PSQI>5. Logistic regression was used to performed both univariate and multivariable analysis. Predictors with p<0.1 in the univariate analysis were included in the multivariable analysis.
Results
A total of 272 patients were included, with 53.3% being male. The median age was 48 years (interquartile range [IQR] 38-58). Ulcerative colitis was present in 184 (68%) patients, while the remaining patients had Crohn's disease. A history of psychopathology was noted in 35 (12.9%) patients. The majority of patients were in clinical remission (245 (90.1%) patients). Poor QoL was reported by 87 (32.7%) and poor sleep quality was reported in 185 (70.1%). Univariate analysis revealed a statistically significant association between female gender, Crohn’s disease, absence of clinical remission, self-reported poorer sleep quality, and illness perception (higher scores in four components: timeline cyclical, illness consequences and coherence, and emotional representation of IBD) and worse HRQoL. Multivariable analysis confirmed younger age, absence of clinical remission, worse sleep quality, and illness perception (illness consequences, coherence, and emotional representation of IBD) as independent predictors of poor HRQoL.
Conclusion
HRQoL in IBD is influenced by factors beyond disease activity. Sleep quality emerges as a significant determinant of HRQoL, alongside the patient's illness perception. Therefore, integrating sleep quality assessment into patient clinical evaluation is paramount. Moreover, addressing patients' understanding of their disease, perspective on consequences, and emotional response to the condition is crucial for improving HRQoL.
References
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Disclosure
FP received speaker fees from Abbvie, Falk, Ferring, Janssen, Pfizer, Pharmakern, Takeda and Tillotts.