Sleep duration affects risk for ulcerative colitis
If you are not getting the recommended seven-to-eight hours of sleep each night, you may be at increased risk of developing ulcerative colitis, according to a new study1 in Clinical Gastroenterology and Hepatology, the official clinical practice journal of the American Gastroenterological Association.
“Both short and long durations of sleep have important health implications and are associated with increased overall mortality, cardiovascular disease and cancer,” said lead study author Ashwin N. Ananthakrishnan, MD, MPH, Massachusetts General Hospital. “Our findings indicate that ulcerative colitis may potentially be added to this list. We found that less than six hours of sleep per day and more than nine hours of sleep per day are each associated with an increased risk of ulcerative colitis.”
Researchers conducted a prospective study of women who were enrolled in the Nurses’ Health Study (NHS) I since 1976 and NHS II since 1989 and followed through detailed biennial questionnaires with greater than 90 percent follow-up. The large size of the cohorts, prospective design and prolonged duration of follow-up provide a unique opportunity to examine the association between sleep duration and incident disease with sufficient power to adjust for potential confounders.
The results demonstrated that there is a “U-shaped” relationship between sleep duration and risk of ulcerative colitis, with both short and long duration of sleep being associated with an increased risk of disease. These observed associations were independent of other known environmental risk factors.
In a previous study2, also published in Clinical Gastroenterology and Hepatology last year, Ananthakrishnan and colleagues had reported that poor sleep quality, even while in remission, resulted in a two fold increase in risk of Crohn’s disease flares at six months. “All these data together support a growing recognition of the impact of sleep disruption on the immune system, and the need for providers to frequently inquire about sleep duration and quality as an important parameter of health in patients with inflammatory bowel diseases,” said Dr. Ananthakrishnan.
The authors acknowledge several study limitations. First, the study population consisted predominantly of white female nurses and is thus not representative of the gender and ethnic distribution in the general population. Sleep duration was also self-reported. However, the size of the study and quality of data substantiate these findings.
Ulcerative colitis is a chronic condition that affects the large intestines, particularly the colon. It is classified as one of the two inflammatory bowel diseases along with Crohn’s disease.
The condition is characterized by inflammation within the linings of the gut walls.
Causes of ulcerative colitis
Ulcerative colitis is considered to be an autoimmune disease. Normally the body’s immune system works to defend the body against infection and invading microbes. In autoimmune disorders, this goes awry and the immune system attacks body’s own cells.
There are billions of harmless bacteria present in the gut. In inflammatory bowel diseases like Crohn’s disease and Ulcerative colitis, the immune system targets these harmless bacteria inside the colon and in turn attacks the tissues of the colon, causing it to become inflamed.
The inflammation leads to formations of ulcers and painful sores oozing mucus and pus. Both genetic and environmental factors may be responsible for causation of ulcerative colitis.
Differences Between Crohn’s Disease and Ulcerative Colitis
Symptoms of Crohn’s Disease
Abdominal pain, cramping or swelling
Anemia
Fever
Gastrointestinal bleeding
Joint pain
Malabsorption
Persistent or recurrent diarrhea
Stomach ulcers
Vomiting
Weight loss
Symptoms of Ulcerative Colitis
Abdominal pain or discomfort
Anemia caused by severe bleeding
Bloody diarrhea
Dehydration
Fatigue
Fever
Joint pain
Loss of appetite
Malabsorption
Rectal bleeding
Urgent bowel movements
Weight loss
Future studies are warranted to better understand mechanisms by which sleep may influence intestinal inflammation.
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To learn more about ulcerative colitis, review the AGA patient brochure on inflammatory bowel disease.
About the AGA Institute
The American Gastroenterological Association is the trusted voice of the GI community. Founded in 1897, the AGA has grown to include more than 16,000 members from around the globe who are involved in all aspects of the science, practice and advancement of gastroenterology. The AGA Institute administers the practice, research and educational programs of the organization. http://www.gastro.org.
About Clinical Gastroenterology and Hepatology
The mission of Clinical Gastroenterology and Hepatology is to provide readers with a broad spectrum of themes in clinical gastroenterology and hepatology. This monthly peer-reviewed journal includes original articles as well as scholarly reviews, with the goal that all articles published will be immediately relevant to the practice of gastroenterology and hepatology.
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Rachel Steigerwald
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American Gastroenterological Association