title: Characterization of relations among sleep, inflammation, and psychiatric dysfunction in depressed youth with Crohn disease.
abstract: OBJECTIVE
  Recent reports demonstrate a link between inflammatory bowel disease (IBD) and sleep disturbance. Increased psychiatric dysfunction is consistently reported in patients with IBD. Our objective is to examine relations among sleep disturbance, inflammation, and psychiatric dysfunction in a pediatric population with Crohn disease (CD) and depression.
  
  
  METHODS
  Pediatric patients with CD with depression (n = 96) and healthy controls (n = 19) completed measures of sleep (Pittsburgh Sleep Quality Index [PSQI]), depression, anxiety, and abdominal pain, and provided blood for inflammatory markers. CD activity was determined by the Pediatric Crohn's Disease Activity Index. Factor analysis was performed on subscales of the PSQI to derive measures of sleep disturbance. Univariate and multivariate regression analyses assessed relations between sleep disturbance, psychosocial, and biological measures of CD and psychiatric dysfunction.
  
  
  RESULTS
  Sleep disturbance in depressed youth with CD was significantly greater than healthy controls, and was significantly related to measures of abdominal pain, depression, and anxiety, but not biomarkers of inflammation. Factor analysis of the PSQI demonstrated a 2-factor solution. The first factor, termed "Qualitative," included Subjective Sleep Quality, Daytime Dysfunction, Sleep Disturbance, and Sleep Latency, whereas the second factor, "Quantitative," consisted of Habitual Sleep Efficiency and Sleep Duration. This factor showed a significant relation to inflammatory markers. Multivariate modeling suggested that qualitative sleep disturbance was predicted by disease activity, pain, and anxiety, whereas quantitative sleep disturbance was predicted by disease activity.
  
  
  CONCLUSIONS
  These results indicate that sleep disturbance in depressed youth with CD differs depending upon illness activity. Patients may require different interventions depending upon the sleep disturbance exhibited.
authors.affiliation: Medical Coping Clinic, Department of Gastroenterology, Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA. benhayond@upmc.edu
authors.forename: David
authors.initials: D
authors.lastname: Benhayon
authors.forename: Ada
authors.initials: A
authors.lastname: Youk
authors.forename: F Nicole
authors.initials: FN
authors.lastname: McCarthy
authors.forename: Stephanie
authors.initials: S
authors.lastname: Davis
authors.forename: David J
authors.initials: DJ
authors.lastname: Keljo
authors.forename: Athos
authors.initials: A
authors.lastname: Bousvaros
authors.forename: Diane
authors.initials: D
authors.lastname: Fairclough
authors.forename: David
authors.initials: D
authors.lastname: Kupfer
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Buysse
authors.forename: Eva M
authors.initials: EM
authors.lastname: Szigethy
mesh_terms: D015746:Abdominal Pain / Q000150:complications; D000293:Adolescent; D001007:Anxiety / Q000150:complications; D015415:Biomarkers / Q000097:blood; D002648:Child; D003424:Crohn Disease / Q000150:complications* / Q000523:psychology; D003863:Depression / Q000150:complications*; D003866:Depressive Disorder / Q000150:complications*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000150:complications*; D018836:Inflammation Mediators / Q000097:blood; D008297:Male; D012044:Regression Analysis; D012890:Sleep; D012893:Sleep Wake Disorders / Q000209:etiology* / Q000523:psychology; D011795:Surveys and Questionnaires
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators