Sleep disturbances and psychological factors as mediators between gastrointestinal symptoms and disease severity in chronic spontaneous urticaria

Background: Dysregulation of gastrointestinal function has been implicated in the pathogenesis of chronic spontaneous urticaria (CSU). Moreover, persistent wheals and pruritus in CSU are frequently accompanied by sleep disturbances and psychological distress. However, whether sleep quality and psychological factors mediate the association between gastrointestinal symptoms and CSU disease severity remains unclear. Methods: This study retrospectively analyzed data from 499 CSU patients. Associations between CSU disease activity and gastrointestinal symptoms, sleep quality, and psychological status were assessed. Mediation analyses were conducted to evaluate whether sleep quality and psychological status mediated the relationship between gastrointestinal symptoms and disease activity. Results: Gastrointestinal symptoms were significantly associated with CSU disease activity. Multivariate analysis identified gastrointestinal symptoms as an independent risk factor for increased CSU disease activity (adjusted OR = 1.85, 95% CI: 1.23-2.78). Among individual gastrointestinal symptoms, diarrhea and abdominal pain showed the strongest correlations. Mediation analyses revealed partial mediation by psychological factors, with sleep disturbance (13.17%), anxiety (17.28%), and stress (21.09%) accounting for significant proportions of the total effect. Conclusion: Gastrointestinal symptoms are independently associated with increased CSU disease activity. This relationship is partially mediated by sleep disturbances, anxiety, and stress, highlighting the relevance of the gut-brain-skin axis in CSU management.