Sleep disturbance in inflammatory bowel disease: clinical associations and gaps in care

Background and aims Sleep disturbance is highly prevalent in inflammatory bowel disease (IBD), affecting up to 70% of patients with active disease and 40% in remission, and is associated with worse clinical and patient-reported outcomes. Understanding of the multifactorial drivers of sleep disturbances in IBD remains limited, and as such, there is an absence of clear guidance for evaluating and managing sleep problems in this population. We aimed to identify factors associated with sleep disturbance and characterize patient beliefs, self-management strategies, and interest in sleep-focused testing and treatments. Methods Adults with Crohn disease and ulcerative colitis completed a cross-sectional survey assessing disease activity, sleep quality, stress, chronotype, fatigue, and mood. A study-specific questionnaire evaluated sleep-related beliefs, behaviors, and treatment interest. Descriptive analyses characterized sleep patterns and behaviors, and multivariable regression identified factors associated with poor sleep. Results Among 204 participants, 76.5% reported poor sleep quality and 55.9% had clinically significant sleep disturbance, which was more common in active disease than remission (80.9% vs 46.0%, P < .001). Active disease (odds ratio [OR], 4.31), higher perceived stress (OR, 1.21), and anxiety (OR, 2.63) were associated with increased odds of clinically significant sleep disturbance, while intermediate (OR, 0.16) and morning chronotypes (OR, 0.07) were associated with lower odds of clinically significant sleep disturbance compared with evening chronotypes. Most participants reported self-management behaviors related to sleep, with widespread use of sleep hygiene and over-the-counter strategies but minimal exposure to cognitive behavioral therapy for insomnia (0.5%). Interest in sleep-focused interventions was high, particularly for wearable monitoring, home-based testing, and behavioral and light-based therapies. Conclusion Sleep disturbance in inflammatory bowel disease is common and reflects interacting inflammatory, psychological, and circadian factors. Use of evidence-based therapies remains extremely limited, highlighting a substantial gap in care.