A systematic review and meta-analysis of sleep quality in inactive inflammatory bowel disease

Background Poor sleep in people with inflammatory bowel disease (IBD) has been demonstrated to be prevalent and has been associated with disease activity. This meta-analysis aimed to assess the relationship between poor sleep in inactive inflammatory bowel disease and controls by considering cohort and cross-sectional studies. Methods Electronic databases were searched for publications from inception to November 1st 2021. Poor sleep was defined according to subjective sleep measures. IBD activity was defined according to subjective measures. A random effects model was used to determine the standardised mean difference between poor sleep in inactive IBD and controls. Publication bias was assessed by funnel plot and Egger’s test. Results 519 studies were screened with 9 studies included in the meta-analysis incorporating a total of 729 people with IBD and 508 controls. A random effects model showed a standardised mean difference with poor sleep more frequent in those with inactive IBD than controls with moderate effect size (Hedge’s g 0.41, CI (0.22-0.59) and no significant heterogenitity. There was no publication bias evident. Conclusion Poor sleep is more common in people with inactive IBD than in controls. This suggests that IBD activity may not be the sole driver of the observed poor sleep in this population. Further studies should consider the role of subclinical inflammation in sleep quality in people with IBD.

背景 炎症性肠病（inflammatory bowel disease, IBD）患者的睡眠障碍患病率较高，且与疾病活动度相关。本荟萃分析旨在通过纳入队列研究与横断面研究，评估非活动期炎症性肠病患者与对照人群的睡眠障碍之间的关联。
方法 检索自建库起始至2021年11月1日的电子数据库文献。睡眠障碍依据主观睡眠评估标准进行定义，炎症性肠病活动度亦采用主观评估标准界定。本研究采用随机效应模型计算非活动期炎症性肠病患者与对照人群睡眠障碍的标准化均数差，并通过漏斗图与Egger检验评估发表偏倚。
结果 共筛选出519项研究，最终纳入9项研究进行荟萃分析，合计纳入729例炎症性肠病患者与508例对照人群。随机效应模型分析结果显示，非活动期炎症性肠病患者的睡眠障碍发生率高于对照人群，效应量中等（赫奇斯g值为0.41，95%置信区间为0.22~0.59），且无显著异质性，未发现明显发表偏倚。
结论 非活动期炎症性肠病患者的睡眠障碍发生率高于对照人群，这提示疾病活动度并非该人群睡眠障碍的唯一影响因素。未来研究应关注亚临床炎症在炎症性肠病患者睡眠质量中的作用。