P207 Poor sleep quality is a risk factor for hospitalisation and surgery in Crohn’s disease

Abstract

Background: Sleep quality is frequently disturbed in patients with inflammatory bowel disease (IBD). Sleep physiology and IBD pathophysiology involve overlapping immunologic and cell signalling relationships. While active IBD promotes poor sleep, prior studies showed that poor sleep can predict clinical relapse. We investigated whether poor sleep quality is a risk factor for hospitalisation or surgery in Crohn's disease (CD). Methods: We performed a cross-sectional study of adult patients with CD recruited from an ambulatory clinic in a tertiary care IBD centre. Study subjects completed a questionnaire that included the validated Pittsburgh Sleep Quality Index (PSQI). “Poor sleep” was defined as a PSQI score >8. Clinical disease activity was simultaneously measured by Harvey-Bradshaw Index (HBI) with “clinical remission” defined as HBI <5. Additional data extracted from the medical records included medical history, medications, and demographics. The subjects were followed until inpatient admission for CD activity or CD-related surgery. A multivariate Cox regression was performed to determine risk factors for the combined outcome of hospitalisation or surgery. Results: 92 patients were followed over a mean of 258 days. While similar in baseline characteristics for age, sex, BMI, and smoking status, patients with poor sleep quality had significantly higher HBI scores at baseline. (Table presented) A multivariate Cox regression including, “poor sleep”, current steroid use, current smoking, any prior surgery, “clinical remission”, body mass index, age, alcohol use, and female sex showed that “poor sleep” (HR 5.37, 95% CI 1.39-27.54) and current steroid use (HR 4.31, 95% CI 1.15-16.50) portended increased risk for hospitalisation or surgery. Female sex conferred a lower risk for the outcome (HR 0.28, 95% CI 0.07-0.94). Conclusions: Poor sleep quality measured by the PSQI is a risk factor for hospitalisation or surgery in Crohn's disease, independent of clinical disease activity. Sleep quality may represent a modifiable risk factor for disease complications, and present an opportunity for further individualising clinical management of patients with CD.