Journal Article Annotations
2023, 4th Quarter
Annotations by Ashwini Nadkarni, MD
This research team aimed to conduct a more comprehensive investigation into the potential links between inflammatory bowel disease (IBD) and the subsequent diagnosis of anxiety and/or depression in a sizable group of outpatients in Germany. The present study offers additional support for the epidemiological association between IBD) and a subsequent diagnosis of depression and/or anxiety within a primary care patient cohort of 16,257 IBD individuals in Germany.
Strength and weaknesses:
The disease database utilized did not contain information on relevant elements such as patient socioeconomic status (such as education and income) or risk factors related to lifestyle (such as smoking, alcohol use, and physical activity), which could introduce bias. Additionally, there was no information provided regarding the diagnostic techniques used to establish the diagnosis of depression, leading to a diagnostic bias. In addition, due to the design of the study, the authors could only infer connections and associations between variables, and not causal links.
The study has important clinical implications in the appropriate screening, management and treatment of patients with IBD and depression and anxiety disorders – pointing to the importance of performing such screening and value of psychiatric care of patients with IBD.
To advance the current understanding of sleep architecture in inflammatory bowel disease (IBD) and produce more methodologically sound results, this study used in-home, multi-night wireless sleep-EEG testing to evaluate sleep architecture across three nights in people with and without IBD. Many of the analyses did not replicate prior research, with the only significant finding indicating that participants with IBD evidenced more micro-arousals than healthy controls.
Strength and weaknesses:
The strengths of the study include its value in the growing body of literature pointing to differences in sleep architecture in patients with IBD. The weaknesses include a small, homogeneous sample that limited power and generalizability. Additionally, the assessment of disease activity was not objective; future research including measures of inflammation such as C reactive protein are needed to better understand the relationships among sleep disturbances, inflammation and IBD symptoms. Further, the findings on psychosocial and behavioral contributors to micro-arousals in IBD are novel but preliminary.
Sleep is a complex phenomenon in patients with IBD who may often wake up during the night due to a need to go to the bathroom. However, this study validates that separately, patients with IBD have differences in their sleep architecture (micro-arousals – which are associated with depression). This study offers C-L psychiatrists emerging data on the need to consider the nature of sleep disturbance in patients with IBD.