Poor Subjective Sleep Quality Predicts Symptoms in Irritable Bowel Syndrome Using the Experience Sampling Method

Am J Gastroenterol. 2024 Jan 1;119(1):155-164. doi: 10.14309/ajg.0000000000002510.Epub 2023 Sep 22.


Rabia Topan 1Lisa Vork 2Heather Fitzke 3Shraya Pandya 1Daniel Keszthelyi 2Jan Cornelis 4Jason Ellis 5Lukas Van Oudenhove 6 7 8Maaike Van Den Houte 6 7Qasim Aziz 1


Author information

1Blizard Institute, Wingate Institute of Neurogastroenterology, Centre for Neuroscience, Surgery and Trauma Barts and the London School of Medicine and Dentistry, Queen Mary University, London, UK.

2Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.

3Centre for Medical Imaging, University College London.

4Imec, Kapeldreef 75, Heverlee, Belgium.

5Northumbria Centre for Sleep Research, Department of Psychology, Northumbria University, UK.

6Laboratory for Brain-Gut Axis Studies (LaBGAS), Translational Research in Gastrointestinal Disorders (TARGID), Department of Chronic Diseases & Metabolism (CHROMETA), KU Leuven, Leuven, Belgium.

7Leuven Brain Institute, KU Leuven, Leuven, Belgium.

8Cognitive & Affective Neuroscience Lab, Department of Psychological & Brain Sciences, Dartmouth College Hanover, New Hampshire, USA.


Introduction: Sleep quality may affect symptom experience in irritable bowel syndrome (IBS). Our aim was to investigate the relationship between sleep quality and gastrointestinal (GI) symptoms using actigraphy and the experience sampling method.

Methods: Patients with IBS were recruited from a tertiary Neurogastroenterology clinic and the community. GI symptoms and mood were recorded on a smartphone application, 10 times per day, over 7 consecutive days. Subjective sleep quality was recorded every morning to reflect the night before. Objective measures of sleep quality were estimated from wrist-worn actigraphy. Cross-lagged structural equation models were built to assess the directionality of sleep-symptom relationships over time.

Results: Eighty patients with IBS completed the study (mean age: 37 years [range 20-68], 89% female, 78% community). Approximately 66% had a Pittsburgh Sleep Quality Index score ≥ 8, indicating a clinically significant sleep disturbance. Approximately 82% (95% CI: 72-90) screened positive for a sleep disorder, most commonly insomnia. In cross-lagged analysis, poor subjective sleep quality predicted next-day abdominal pain (0.036 < P < 0.040) and lower GI symptoms (0.030 < P < 0.032), but not vice versa. No significant relationship with GI symptoms was found for any objective sleep measure using actigraphy.

Discussion: Poor subjective sleep quality was associated with higher next-day lower GI symptom levels, but not vice versa. Objective sleep measures did not predict next-day abdominal symptoms, potentially supporting the conclusion that it is the perception of sleep quality that is most influential. This study may be used to guide future research into the effect of sleep interventions on GI symptoms.

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