title: Increased use of hypnotics in individuals with celiac disease: a nationwide case-control study.
abstract: BACKGROUND
  Although poor sleep is common in numerous gastrointestinal diseases, data are scarce on the risk of poor sleep in celiac disease. The objective of this study was to estimate the risk of repeated use of hypnotics among individuals with celiac disease as a proxy measure for poor sleep.
  
  
  METHODS
  This is a nationwide case-control study including 2933 individuals with celiac disease and 14,571 matched controls from the general Swedish population. Poor sleep was defined as ≥2 prescriptions of hypnotics using prospective data from the National Prescribed Drug Register (data capture: July 2005-January 2008). We estimated odds ratios and hazard ratios for poor sleep before and after celiac disease diagnosis respectively.
  
  
  RESULTS
  In this study, poor sleep was seen in 129/2933 individuals (4.4%) with celiac disease, as compared with 487/14,571 controls (3.3%) (odds ratio = 1.33; 95% CI = 1.08-1.62). Data restricted to sleep complaints starting ≥1 year before celiac disease diagnosis revealed largely unchanged risk estimates (odds ratio = 1.23; 95% CI = 0.88-1.71) as compared with the overall risk (odds ratio 1.33). The risk of poor sleep in celiac disease was essentially not influenced by adjustment for concomitant psychiatric comorbidity (n = 1744, adjusted odds ratio =1.26; 95% CI = 1.02-1.54) or restless legs syndrome (n = 108, adjusted odds ratio = 1.33; 95% CI = 1.08-1.63). Poor sleep was also more common after celiac disease diagnosis as compared with matched controls (hazard ratio = 1.36; 95% CI = 1.30-1.41).
  
  
  CONCLUSIONS
  In conclusion, individuals with celiac disease suffer an increased risk of poor sleep, both before and after diagnosis. Although we cannot rule out that surveillance bias has contributed to our findings, our results are consistent with previous data suggesting that sleep complaints may be a manifestation of celiac disease.
authors: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. karlmarild@gmail.com.|Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway. karlmarild@gmail.com.|Astrid Lindgren Children's Hospital, Stockholm, Sweden. karlmarild@gmail.com.
authors: Karl
authors: K
authors: Mårild
authors: Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA. TMorgenthaler@mayo.edu.
authors: Timothy I
authors: TI
authors: Morgenthaler
authors: Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA. somers.Virend@mayo.edu.
authors: Virend K
authors: VK
authors: Somers
authors: Departments of Neurology and Pediatrics, The Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA. Kotagal.Suresh@mayo.edu.
authors: Suresh
authors: S
authors: Kotagal
authors: Departments of Medicine and Immunology, Mayo Clinic, Rochester, MN, USA. Murray.Joseph@mayo.edu.
authors: Joseph A
authors: JA
authors: Murray
authors: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. jonasludvigsson@yahoo.com.|Department of Pediatrics, Örebro University Hospital, Örebro, Sweden. jonasludvigsson@yahoo.com.
authors: Jonas F
authors: JF
authors: Ludvigsson
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002446:Celiac Disease / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D012148:Restless Legs Syndrome / Q000453:epidemiology; D018570:Risk Assessment; D012893:Sleep Wake Disorders / Q000188:drug therapy / Q000453:epidemiology*; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult
chemical_list: D006993:Hypnotics and Sedatives
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