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Background: Sleep difficulties play an important role in the maintenance and course of chronic abdominal pain disorders (RAP and IBD). Particularly among adolescents with inflammatory bowel diseases (IBD) or recurrent abdominal pain (RAP), adequate sleep seems to be important, as the diseases self and the associated symptoms can cause distress and impair daytime functioning. Hence it seems adequate to take a closer look concerning the sleep difficulties within the different conditions of abdominal pain especially in comparison to a healthy control. To our knowledge no former study compared sleep problems in youths with RAP and IBD as well as healthy controls. Thus the aim of the present study was to 1) evaluate sleep problems in the RAP and IBD and 2) compare the sleep problems of these abdominal pain diseases with a healthy control group.
Methods: 129 adolescents (14-25 years) took part in the online survey, with 58 suffering from IBD, 23 had RAP and 48 healthy controls. Adolescents completed sleep questionnaires as PSQI, SDSC or NEQ. Data was analysed by conducting MANOVAs to test differences between the three groups followed by a post-hoc analyses.
Results: Significant differences between both patient groups and healthy controls regarding sleep quality as well as sleep disturbances were found. Results indicate that especially young IBD patients suffered more often from poor sleep quality, sleep disturbances as well as daily effects of nightmares than the control group. The comparison of adolescents with RAP and healthy controls showed elevated scores concerning sleep disturbances for RAP patients. However, IBD and RAP adolescents did not differ significantly concerning most sleep measurements.
Discussion: The study at hand was the first to compare adolescents with IBD and RAP regarding sleep difficulties. Adolescents with IBD and RAP have an impaired sleep quality as well as a higher rate of sleep disturbances and suffer from daily effects of nightmares than the control group. Therefore sleep disturbances should be also addressed when treating IBD and RAP patients to prevent further impairments.
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- Scharff L. Recurrent abdominal pain in children: a review of psychological factors and treatment. Clinical psychology review, 1997, 17(2): 145-166. https://doi.org/10.1016/S0272-7358(96)00001-3
- Schlarb AA, Gulewitsch MD, Bock genannt Kasten I, et al. Recurrent abdominal pain in children and adolescents - a survey among paediatricians. GMS Psycho-Social-Medicine. 2011, 8: 1-7.
- Rasquin A, Di Lorenzo C, Forbes D, et al. Childhood functional gastrointestinal disorders: child / adolescent. Gastroenterology, 2006, 130(5): 1527-1537. https://doi.org/10.1053/j.gastro.2005.08.063
- Abu-Arafeh I and Russell G. Prevalence and clinical features of abdominal migraine compared with those of migraine headache. Archives of disease in childhood, 1995, 72(5): 413-417. https://doi.org/10.1136/adc.72.5.413
- Hyams JS, Burke G, Davis PM, et al. Abdominal pain and irritable bowel syndrome in adolescents: a community-based study. The Journal of pediatrics, 1996, 129(2): 220-226. https://doi.org/10.1016/S0022-3476(96)70246-9
- Youssef NN, Atienza K, Langseder AL, et al. Chronic abdominal pain and depressive symptoms: analysis of the national longitudinal study of adolescent health. Clinical Gastroenterology and Hepatology, 2008, 6(3): 329-332. https://doi.org/10.1016/j.cgh.2007.12.019
- Saps M, Seshadri R, Sztainberg M, et al. A prospective school-based study of abdominal pain and other common somatic complaints in children. The Journal of pediatrics, 2009, 154(3): 322-326. https://doi.org/10.1016/j.jpeds.2008.09.047
- Youssef NN, Murphy TG, Langseder AL, et al. Quality of life for children with functional abdominal pain: a comparison study of patients’ and parents’ perceptions. Pediatrics, 2006, 117(1): 54-59. https://doi.org/10.1542/peds.2005-0114
- Drossman DA. Gastrointestinal illness and the biopsychosocial model. Psychosomatic medicine, 1998, 60(3): 258-267. https://doi.org/10.1097/00006842-199805000-00007
- Huntley ED, Campo JV, Dahl RE, et al. Sleep characteristics of Youth with Functional Abdominal Pain and a Healthy Comparison Group. J of Pediatr. Psychology, 2007, 32(8): 938-949. https://doi.org/10.1093/jpepsy/jsm032
- Haim A, Pillar G, Pecht A, et al. Sleep patterns in children and adolescents with functional recurrent abdominal pain: objective versus subjective assessment. Acta Paediatrics, 2004, 93(5): 677-680. https://doi.org/10.1111/j.1651-2227.2004.tb02996.x
- Kim HJ. Importance of sleep quality in functional abdominal pain disorder in pediatric patients. Sleep and Biological Rhythms, 2021: 1-5. https://doi.org/10.1007/s41105-021-00342-9
- Wang B, Duan R and Liping D. Prevalence of sleep disorder in irritable bowel syndrome: A systematic review with meta-analysis. Saudi Journal of Gastroenterology, 2018, 24(3): 141-150. https://doi.org/10.4103/sjg.SJG_603_17
- Pavlova M, Ference J, Hancock M, et al. Disentangeling the Sleep Pain Relationship in Pediatric Chronic Pain: The Mediating Role of Internalizing Mental Health Symptoms. Pain Research and Management, 2017. https://doi.org/10.1155/2017/1586921
- Abraham C and Cho JH. Inflammatory bowel disease. New England Journal of Medicine, 2009, 361: 2066-2078. https://doi.org/10.1056/NEJMra0804647
- Loftus EV. Clinical epidemiology of inflammatory bowel disease: Incidence, Prevalence, and Environmental Influences. Gastroenterol, 2004, 126: 1504-1517. https://doi.org/10.1053/j.gastro.2004.01.063
- Zimmerman J. Extraintestinal symptoms in irritable bowel syndrome and inflammatory bowel diseases: nature, severity, and relationship to gastrointestinal symptoms. Dig Dis Science, 2003, 48(4): 743- 749. https://doi.org/10.1023/A:1022840910283
- Guan Q. A Comprehensive Review and Update on the Pathogenesis of Inflammatory Bowel Disease. Journal of immunology research, 2019, 2019: 7247238. https://doi.org/10.1155/2019/7247238
- Benchimol EI, Fortinsky KJ, Gozdyra P, et al. Epidemiology of pediatric inflammatory bowel disease: a systematic review of international trends. Inflammatory Bowel Diseases, 2011, 17(1): 423-439. https://doi.org/10.1002/ibd.21349
- Guilfoyle SM, Gray WN, Herzer-Maddux M, et al. Parenting stress predicts depressive symptoms in adolescents with inflammatory bowel disease. European Journal of Gastroenterology & Hepatology, 2014, 26(9): 964-971. https://doi.org/10.1097/MEG.0000000000000149
- Amre DK, Lu SE, Costea F, et al. Utility of serological markers in predicting the early occurrence of complications and surgery in pediatric Crohn’s disease patients. American Journal of Gastroenterology, 2006, 101(3): 645-652. https://doi.org/10.1111/j.1572-0241.2006.00468.x
- Bousvaros A, Sylvester F, Kugathasan S, et al. Challenges in pediatric inflammatory bowel disease. Inflammatory Bowel Diseases, 2006, 12(9): 885-913. https://doi.org/10.1097/01.mib.0000228358.25364.8b
- Dubinsky MC, Lin YC, Dutridge D, et al. Serum immune responses predict rapid disease progression among children with Crohn’s disease: immune responses predict disease progression. American Journal of Gastroenterology, 2006, 101(2): 360-367. https://doi.org/10.1111/j.1572-0241.2006.00456.x
- Engelmann G, Erhard D, Petersen M, et al. Health-related quality of life in adolescents with inflammatory bowel disease depends on disease activity and psychiatric comorbidity. Child Psychiatry & Human Development, 2015, 46(2): 300-307. https://doi.org/10.1007/s10578-014-0471-5
- Starpersma L, van den Brink G, van der Ende J, et al. Illness Perception and Depression Are Associated with Health-Related Quality of Life in Youth with Inflammatory Bowel Disease. International Journal of Behavioral Medicine, 2019, 26: 415-426. https://doi.org/10.1007/s12529-019-09791-6
- Gamwell KL, Baudino MN, Bakula DM, et al. Perceived Illness Stigma. Thwarted Belongingness, and Depressive Symptoms in Youth With Inflammatory Bowel Disease (IBD). Inflamm Bowel Disease, 2018, 24(5): 960-965. https://doi.org/10.1093/ibd/izy011
- Selemon LD. A role for synaptic plasticity in the adolescent development of executive function. Translational Psychiatry, 2013, 3: 1-9. https://doi.org/10.1038/tp.2013.7
- Ananthakrishnan AN, Long MD, Martin CF, et al. Sleep disturbance and risk of active disease in patients with Crohn’s disease and ulcerative colitis. Clinical Gastroenterology and Hepatology, 2013, 11(8): 965-971. https://doi.org/10.1016/j.cgh.2013.01.021
- Sobolewska-Wlodarczyk A, Wlodarczyk M, Banaski J, et al. Sleep disturbances and disease activity in adult patients with inflammatory bowel disease. Journal of Physiology and Pharmacology, 2018, 69(3): 423-428. https://doi.org/10.26402/jpp.2018.3.09
- Ranjbaran Z, Keefer L, Stepanski E, et al. The relevance of sleep abnormalities to chronic inflammatory conditions. Inflammation Research, 2007, 56(2): 51-57. https://doi.org/10.1007/s00011-006-6067-1
- Schredl M, Fricke-Oerkermann L, Mitschke A, et al. Longitudinal Study of Nightmares in Children: Stability and Effect of Emotional Symptoms. Child Psychiatry & Human Development, 2009, 40(3): 439-449. https://doi.org/10.1007/s10578-009-0136-y
- Pirinen T, Kolho KL, Simola P, et al. Parent and Self-Report of Sleep-Problems and Daytime Tiredness Among Adolescents With Inflammatory Bowel Disease and Their Population-Based Controls. Sleep, 2010, 33(11): 1487-1493. https://doi.org/10.1093/sleep/33.11.1487
- QuestBack AG. Unipark. EFS Survey Software, 2015.
- Buysse DJ, Reynolds CF, Monk TH, et al. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research, 1989, 28(2): 193-213. https://doi.org/10.1016/0165-1781(89)90047-4
- Mollayeva T, Thurairajah P, Burton K, et al. The Pittsburgh sleep quality index as a screening tool for sleep dysfunction in clinical and non-clinical samples: a systematic review and meta-analysis. Sleep medicine reviews, 2016, 25: 52-73. https://doi.org/10.1016/j.smrv.2015.01.009
- Chiu HY, Chang LY, Hsieh YJ, et al. A meta-analysis of diagnostic accuracy of three screening tools for insomnia. Journal of psychosomatic research, 2016, 87: 85-92. https://doi.org/10.1016/j.jpsychores.2016.06.010
- Wittchen HU, Krause P, Höfler M, et al. NISAS-2000-die “Nationwide Insomnia Screening and Awareness Study”, 2001.
- Backhaus J, Junghanns K, Broocks A, et al. Test-retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia. Journal of Psychosomatic Research, 2002, 53(3): 737-740. https://doi.org/10.1016/S0022-3999(02)00330-6
- Schlarb AA, Zschoche M and Schredl M. Der Nightmare Effects Questionnaire (NEQ). Pilotstudie zu ersten psychometrischen Kennwerten bei Jugendlichen und jungen Erwachsenen. Somnologie, 2016, 20(4): 251-257. https://doi.org/10.1007/s11818-016-0086-0
- Bruni O, Ottaviano S, Guidetti V, et al. The Sleep Disturbance Scale for Children (SDSC) Construct ion and validation of an instrument to evaluate sleep disturbances in childhood and adolescence. Journal of sleep research, 1996, 5(4): 251-261. https://doi.org/10.1111/j.1365-2869.1996.00251.x
- Cohen J. Statistical Power Analysis for the Behavioral Sciences (2. Aufl.). London, UK: Taylor & Francis, 1988.
- Benhayon D, Youk A, McCarthy FN, et al. Characterization of relations among sleep, inflammation, and psychiatric dysfunction in depressed youth with Crohn’s disease. Journal of Pediatric Gastroenterology & Nutrition, 2013, 57(3): 335-342. https://doi.org/10.1097/MPG.0b013e31829641df
- Ali T, Madhoun MF, Orr WC, et al. Assessment of the relationship between quality of sleep and disease activity in inflammatory bowel disease patients. Inflammatory Bowel Diseases, 2013, 19(11): 2440-2443. https://doi.org/10.1097/MIB.0b013e3182a0ea54
- Uemura R, Fujiwara Y, Iwakura N, et al. Sleep disturbances in Japanese patients with inflammatory bowel disease and their impact on disease flare. Springer Plus, 2016, 5(1): 1792. https://doi.org/10.1186/s40064-016-3408-6
- Forrest CB, Forrest KD, Clegg JL, et al. Establishing the content validity of PROMIS Peditric pain interference, fatigue, sleep disturbance, and sleep-related impairment measures in children with chronic kidney disease and Crohn’s disease. Journal of Patient-Reported Outcomes, 2020, 4: 11. https://doi.org/10.1186/s41687-020-0178-2
- Jarasvaraparn C, Zlomke K, Vann NC, et al. The realtionship between sleep disturbance, and disease activity in pediatric patients with inflammatory bowel disease. Journal of Pediatric Gastroenterology and Nutrition, 2019, 68(2): 237-243. https://doi.org/10.1097/MPG.0000000000002156
- Werkstetter KJ, Ullrich J, Schatz SB, et al. Lean body mass, physical activity and quality of life in paediatric patients with inflammatory bowel disease and in healthy controls. Journal of Crohn’s and Colitis, 2012, 6(6): 665-673. https://doi.org/10.1016/j.crohns.2011.11.017
- Manhart AK, Hellmann S, Hamelmann E, et al. The association of sleep with inflammatory bowel disease in children and adolescents. Somnologie, 2016, 20(3): 212-218. https://doi.org/10.1007/s11818-016-0067-3
- Wirtz PH, von Känel R, Mohiyeddini C, et al. Low social support and poor emotional regulation are associated with increased stress hormone reactivity to mental stress in systemic hypertension. The Journal of Clinical Endocrinology & Metabolism, 2006, 91(10): 3857-3865. https://doi.org/10.1210/jc.2005-2586
- Barriga AQ, Doran JW, Newell SB, et al. Relationships between problem behaviors and academic achievement in adolescents: The unique role of attention problems. Journal of Emotional and Behavioral disorders, 2002, 10(4): 233-240. https://doi.org/10.1177/10634266020100040501
- Purabdollah M. Relationship between Sleep, Pain and Inflammatory Markers in Patients with Rheumatoid Arthritis. Journal of Caring Sciences, 2017, 6(3): 249. https://doi.org/10.15171/jcs.2017.024
- Bruni O, Fabrizi P, Ottaviano S, et al. Prevalence of sleep disorders in childhood and adolescence with headache: a case-control study. Cephalalgia, 1997, 17(4): 492-498. https://doi.org/10.1046/j.1468-2982.1997.1704492.x
- Miller VA, Palermo TM, Powers SW, et al. Migraine headaches and sleep disturbances in children. Headache: The Journal of Head and Face Pain, 2003, 43(4): 362-368. https://doi.org/10.1046/j.1526-4610.2003.03071.x
- Schurman JV, Friesen CA, Dai H, et al. Sleep problems and functional disability in children with functional gastrointestinal disorders: an examination of the potential mediating effects of physical and emotional symptoms. BMC gastroenterology, 2012, 12(1): 142. https://doi.org/10.1186/1471-230X-12-142
- Ernst AR, Routh DK and Harper DC. (1984). Abdominal pain in children and symptoms of somatization disorder. Journal of Pediatric Psychology, 1984, 9(1): 77-86. https://doi.org/10.1093/jpepsy/9.1.77
- Routh DK, Ernst AR and Harper DC. Recurrent abdominal pain in children and somatization disorder. In D. K. Routh (Ed.), Handbook of pediatric psychology (pp. 492-504). New York, NY, US: Guilford Press, 1988.
- Baumgart DC and Sandborn WJ. Inflammatory bowel disease: clinical aspects and established and evolving therapies. The Lancet, 2007, 369(9573): 1641-1657. https://doi.org/10.1016/S0140-6736(07)60751-X
- Pirinen T, Kolho KL, Ashorn M, et al. Sleep and Emotional and Behavioral Symptoms in Adolescents with Inflammatory Bowel Disease. Sleep Disorders, 2014, 2014: 379450. https://doi.org/10.1155/2014/379450