Elevated C-Reactive Protein Is Associated With Poor Sleep Quality In Patients With Inflammatory Bowel Disease

Introduction: Stress and poor sleep quality have long been cited as triggers of relapse in inflammatory bowel disease ((IBD); Crohn’s disease (CD), ulcerative colitis (UC)), and previously correlated with disease activity. However, prior studies have focused on symptomatic relapses. Correlating objective inflammatory markers, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) with measures of sleep quality and depressive symptoms can help establish a clear relationship between inflammation and mental health. Methods: This was a single center study including patients recruited as part of an ongoing IBD registry. Patients had documented CD or UC, diagnosed according to standard criteria. Patients enrolled in the registry were invited to complete 16 questions assessing depressive symptoms, and 8 questions assessing sleep quality derived from the NIH PROMIS patient-reported questionnaire set. Of the 256 patients who completed sleep and depression scores, 131 had CRP and ESR measured on the same day they completed the survey (122 CRP, 124 ESR). The questions were scored per guidelines with higher values representing greater disruption of sleep quality or mood. Linear regression models were created to define independent effect of elevated CRP and ESR and depressive symptoms and sleep quality. Results: This study included 131 patients (78 CD and 53 UC/IC patients). Just over half were female (55%). The median age at diagnosis was 25 years. One-fifth of the cohort had history of bowel surgery (22%) and over half had used at least one biologic agent (56%). The mean CRP and ESR levels were 2 mg/dL (standard deviation [SD]=15.89) and 8 mm/hr (SD=16.13) respectively. Twenty-three patients (19%) had an elevated CRP (≥8 mg/dL). Interestingly, patients with high CRP had a 3 point worse sleep score (+3.57, 95% confidence interval [CI] 0.37-6.79) than those with a normal CRP while this relationship was not seen with an elevated ESR (>20 mm/hr). On multivariate analysis, greater depressive symptom score (0.26, 95% CI 0.15-0.37) and high CRP (3.03, 95% CI 0.04-6.03) were independently associated with poor sleep quality. High CRP did not demonstrate a statistically significant correlation with depressive symptoms. High ESR levels did not show a statistically significant correlation with depression or sleep quality. Conclusion: Patients with elevated CRP had worse sleep quality than those with normal levels. More research should be done to determine if CRP levels can be predictive of sleep disruption even of the absence of clinical activity in IBD.