Impact of Advanced Crohn's Disease Therapies on Sleep Quality

Inflammatory bowel diseases (IBD) are chronic inflammatory diseases with a relapsing remitting course. The pathogenesis of the disease is hypothesized to be abnormal host immune response to the gut microbiota, triggered by dietary, environmental or stress factors in genetically predisposed individuals. Despite the significant medical progress with the advent of therapy (e.g., TNF, integrin and cytokine inhibitors, jak inhibitors and S1P receptor modulators) there are still many caveats in the treatment of patients with IBD, including loss of response, immunogenicity, immunosuppression and side effects. Furthermore, although current therapies improve health associated quality of life, there is still unmet gap in this area with high rates of disability, sleep disturbances, fatigue, pain and other quality of life domains.

Sleep and circadian rhythm disorders effect the immune system function and are a potential cause of disease flare-ups, which in turn effect sleep pattern and quality, creating a vicious cycle. The interactions between sleep and inflammation are complex. An effective immune system affects sleep, and sleep disorders affect the functioning of the immune system. Patients with sleep disorders showed increase in inflammatory activity. However, it is difficult to dissect the cause and effect for these associations, given their complex interactions.

Studies identified several risk factors associated with sleep disorders in patients with IBD. These include depression, anxiety, active disease, older age (>52 years), CD duration (>12 years), low hemoglobin levels (<12 g/dL), elevated C-reactive protein (CRP), current corticosteroid use, ongoing anti-TNF therapy, opioid use, and smoking.

Previous studies on the association of sleep abnormalities and IBD relied on self-assessment questionnaires, such as the Pittsburgh Sleep Quality Index (PSQI), which are inherently subjective measures of sleep quality. In this study, the investigators will use the Fitbit Inspire 3 to objectively assess sleep quality, leveraging its ability to track sleep duration and stages.

Sleep is a vital physiological process encompassing two primary modes: Non-Rapid Eye Movement (NREM) and Rapid Eye Movement (REM) sleep. NREM sleep, divided into stages N1, N2, and N3. In N1, the body starts to relax; N2 brings deeper relaxation with a slower heart rate; and in N3, the deepest stage. REM sleep, characterized by vivid dreaming and heightened brain activity similar to wakefulness, is essential for cognitive functions like memory consolidation, emotional processing, and learning. Throughout the night, individuals cycle through NREM and REM phases, each contributing uniquely to physical and mental well-being, underscoring the importance of quality sleep for overall health.