Altered sleep quality is associated with Crohn’s disease activity: an actimetry study

  • Thomas Bazin
  • Jean-Arthur Micoulaud Franchi
  • Nathalie Terras
  • Jacques Taillard
  • David Laharie
  • Frank Zerbib
  • Pierre PhilipEmail author
Sleep Breathing Physiology and Disorders • Original Article



Sleep is involved in the regulation of inflammation, healing, and digestion. The pathophysiology of Crohn’s disease (CD) is unclear, and the role of sleep disturbances has recently been suggested.


The present study investigated a putative association between sleep disturbances and CD activity.


We conducted a prospective observational monocenter translational study, recruiting major CD patients from 2013 to 2015. Disease activity was assessed by the Harvey-Bradshaw index and the CD activity index. Objective sleep quantity and quality were measured by wrist actigraphy over a period of 7 days. The primary objective was to look for an association between wrist actigraphy parameters and CD activity.


Thirty-four CD patients, including 14 with active disease and 20 in remission, were included. Sleep efficiency measured by wrist actigraphy was lower in patients with active CD compared to patients in remission. Wake after sleep onset time best predicted CD activity with an AUROC of 0.83. Patients with active CD were more frequently characterized as “poor sleepers” and frequently suffered from excessive daytime sleepiness.


Sleep efficiency is lower in patients with active CD than in those in remission. Further studies aimed at better characterizing CD patients’ sleep are warranted.


Crohn’s disease Wrist actigraphy Sleep quality 



We thank the clinical research associates from the gastroenterology department and GENPHASS.

Compliance with ethical standards

Conflict of interest

The authors declare that they no conflict of interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Zhang M, Sun K, Wu Y, Yang Y, Tso P, Wu Z (2017) Interactions between intestinal microbiota and host immune response in inflammatory bowel disease. Front Immunol 8:942CrossRefGoogle Scholar
  2. 2.
    Abegunde AT, Muhammad BH, Bhatti O, Ali T (2016) Environmental risk factors for inflammatory bowel diseases. World J Gastroenterol 22(27):6296–6317CrossRefGoogle Scholar
  3. 3.
    Hoogerwerf WA (2009) Role of biological rhythms in gastrointestinal health and disease. Rev Endocr Metab Disord 10(4):293–300CrossRefGoogle Scholar
  4. 4.
    Orr WC (2009) Sleep and gastrointestinal disease: a new horizon in sleep medicine. Sleep Med juin 10(6):595–596CrossRefGoogle Scholar
  5. 5.
    Asif N, Iqbal R, Nazir CF (2017) Human immune system during sleep. Am J Clin Exp Immunol 6(6):92–96Google Scholar
  6. 6.
    Irwin MR, Olmstead R, Carroll JE (2016) Sleep disturbance, sleep duration, and inflammation: a systematic review and meta-analysis of cohort studies and experimental sleep deprivation. Biol Psychiatry 80(1):40–52CrossRefGoogle Scholar
  7. 7.
    Parekh PJ, Oldfield EC, Johnson DA (2018) The effects of sleep on the commensal microbiota: eyes wide open? J Clin Gastroenterol 52(3):204–209Google Scholar
  8. 8.
    Kanaly T, Shaheen NJ, Vaughn BV (nov 2009) Gastrointestinal physiology and digestive disorders in sleep. Curr Opin Pulm Med 15(6):571–577Google Scholar
  9. 9.
    Edwards RR, Almeida DM, Klick B, Haythornthwaite JA, Smith MT (2008) Duration of sleep contributes to next-day pain report in the general population. Pain 137(1):202–207CrossRefGoogle Scholar
  10. 10.
    Marcus SB, Strople JA, Neighbors K, Weissberg-Benchell J, Nelson SP, Limbers C et al (2009) Fatigue and health-related quality of life in pediatric inflammatory bowel disease. Clin Gastroenterol Hepatol 7(5):554–561CrossRefGoogle Scholar
  11. 11.
    Graff LA, Vincent N, Walker JR, Clara I, Carr R, Ediger J, Miller N, Rogala L, Rawsthorne P, Lix L, Bernstein CN (2011) A population-based study of fatigue and sleep difficulties in inflammatory bowel disease. Inflamm Bowel Dis 17(9):1882–1889CrossRefGoogle Scholar
  12. 12.
    Ranjbaran Z, Keefer L, Farhadi A, Stepanski E, Sedghi S, Keshavarzian A (2007) Impact of sleep disturbances in inflammatory bowel disease. J Gastroenterol Hepatol 22(11):1748–1753CrossRefGoogle Scholar
  13. 13.
    Swanson GR, Burgess HJ, Keshavarzian A (2011) Sleep disturbances and inflammatory bowel disease: a potential trigger for disease flare? Expert Rev Clin Immunol 7(1):29–36CrossRefGoogle Scholar
  14. 14.
    Ananthakrishnan AN, Long MD, Martin CF, Sandler RS, Kappelman MD (2013) Sleep disturbance and risk of active disease in patients with Crohn’s disease and ulcerative colitis. Clin Gastroenterol Hepatol 11(8):965–971CrossRefGoogle Scholar
  15. 15.
    van Langenberg DR, Papandony MC, Gibson PR Sleep and physical activity measured by accelerometry in Crohn’s disease. Aliment Pharmacol Ther 41(10):991–1004Google Scholar
  16. 16.
    Keefer L, Stepanski EJ, Ranjbaran Z, Benson LM, Keshavarzian A (2006) An initial report of sleep disturbance in inactive inflammatory bowel disease. J Clin Sleep Med 2(4):409–416Google Scholar
  17. 17.
    Ali T, Madhoun MF, Orr WC, Rubin DT (2013) Assessment of the relationship between quality of sleep and disease activity in inflammatory bowel disease patients. Inflamm Bowel Dis 19(11):2440–2443CrossRefGoogle Scholar
  18. 18.
    Van Assche G, Dignass A, Panes J, Beaugerie L, Karagiannis J, Allez M et al (2010) The second European evidence-based consensus on the diagnosis and management of Crohn’s disease: definitions and diagnosis. J Crohns Colitis févr 4(1):7–27CrossRefGoogle Scholar
  19. 19.
    Harvey RF, Bradshaw JM (1980) A simple index of Crohn’s-disease activity. Lancet 8 mars 1(8167):514CrossRefGoogle Scholar
  20. 20.
    Winship DH, Summers RW, Singleton JW, Best WR, Becktel JM, Lenk LF et al (1979) National Cooperative Crohn’s Disease Study: study design and conduct of the study. Gastroenterology. 77(4 Pt 2):829–842CrossRefGoogle Scholar
  21. 21.
    Guyatt G, Mitchell A, Irvine EJ, Singer J, Williams N, Goodacre R, Tompkins C (1989) A new measure of health status for clinical trials in inflammatory bowel disease. Gastroenterology 96(3):804–810CrossRefGoogle Scholar
  22. 22.
    Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67(6):361–370CrossRefGoogle Scholar
  23. 23.
    Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28(2):193–213CrossRefGoogle Scholar
  24. 24.
    Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14(6):540–545CrossRefGoogle Scholar
  25. 25.
    Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP (1999) Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 131(7):485–491CrossRefGoogle Scholar
  26. 26.
    Tang Y, Preuss F, Turek FW, Jakate S, Keshavarzian A (2009) Sleep deprivation worsens inflammation and delays recovery in a mouse model of colitis. Sleep Med 10(6):597–603CrossRefGoogle Scholar
  27. 27.
    Preuss F, Tang Y, Laposky AD, Arble D, Keshavarzian A, Turek FW (2008) Adverse effects of chronic circadian desynchronization in animals in a “challenging” environment. Am J Physiol Regul Integr Comp Physiol 295(6):R2034–R2040CrossRefGoogle Scholar
  28. 28.
    Voigt RM, Forsyth CB, Green SJ, Mutlu E, Engen P, Vitaterna MH, Turek FW, Keshavarzian A (2014) Circadian disorganization alters intestinal microbiota. PLoS One 9(5):e97500CrossRefGoogle Scholar
  29. 29.
    Lockley SW, Skene DJ, Arendt J (1999) Comparison between subjective and actigraphic measurement of sleep and sleep rhythms. J Sleep Res 8(3):175–183CrossRefGoogle Scholar
  30. 30.
    Vermeire S, Schreiber S, Sandborn WJ, Dubois C, Rutgeerts P (2010) Correlation between the Crohn’s disease activity and Harvey-Bradshaw indices in assessing Crohn’s disease severity. Clin Gastroenterol Hepatol 8(4):357–363CrossRefGoogle Scholar
  31. 31.
    Mikocka-Walus AA, Turnbull DA, Moulding NT, Wilson IG, Holtmann GJ, Andrews JM (2008) Does psychological status influence clinical outcomes in patients with inflammatory bowel disease (IBD) and other chronic gastroenterological diseases: an observational cohort prospective study. Biopsychosoc Med 2:11CrossRefGoogle Scholar
  32. 32.
    Wittmann M, Dinich J, Merrow M, Roenneberg T (2006) Social jetlag: misalignment of biological and social time. Chronobiol Int 23(1–2):497–509CrossRefGoogle Scholar
  33. 33.
    Parekh PJ, Oldfield Iv EC, Challapallisri V, Ware JC, Johnson DA (2015) Sleep disorders and inflammatory disease activity: chicken or the egg? Am J Gastroenterol 110(4):484–488CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.University of Bordeaux, INRA, EA 3671, CHU BordeauxBordeauxFrance
  2. 2.Gastroenterology and Hepatology Department, Hôpital Haut LévêqueCentre Hospitalier Universitaire de Bordeaux and Université de BordeauxBordeauxFrance
  3. 3.University Bordeaux, CNRS, SANPSY, USR 3413BordeauxFrance
  4. 4.Bordeaux Hospital University CenterClinique du sommeilBordeauxFrance
  5. 5.GENPPHASS, Hôpital Pellegrin, Tripode 13ème Etage, Place Amélie Raba LéonBordeaux CEDEXFrance

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