Background/Aims: We aimed to investigate gastrointestinal symptoms, clinical characteristics, and psychological factors in subjects with and without sleep disturbance (SD) in a health screening cohort. Methods: We enrolled 2,752 consecutive subjects during their health checkups. All participants underwent an evaluation with questionnaires. Demographic characteristics and biochemical data were recorded. SD was confirmed when Pittsburgh Sleep Quality Index score was greater than 5. Results: Among the study population (n = 2,674), 956 (36%) individuals had SD. SD was associated with female gender, older age, lower level of education, higher systolic blood pressure, higher serum high-density lipoprotein levels and higher prevalence of functional dyspepsia and irritable bowel syndrome (IBS). SD subjects also had more depression, more anxiety, more severe gastrointestinal reflux disease symptoms and higher prevalence of non-erosive reflux disease (NERD; p < 0.001). SD was ­independently associated with female gender (OR 1.75, < 0.001), older age (OR 1.03, p < 0.001), NERD (OR 1.88, p = 0.004), IBS (OR 1.51, p = 0.043), and depression (OR 1.16, p < 0.001) by multivariate analysis. Conclusions: Future studies will be needed to clarify the interrelationships among SD, psychological stress, and functional gastrointestinal disorders.

1.
Fass R, Fullerton S, Tung S, Mayer EA: Sleep disturbances in clinic patients with functional bowel disorders. Am J Gastroenterol 2000; 95: 1195–2000.
2.
Iwakura N, Fujiwara Y, Shiba M, Ochi M, Fukuda T, Tanigawa T, Yamagami H, Tominaga K, Watanabe T, Arakawa T: Characteristics of sleep disturbances in patients with gastroesophageal reflux disease. Intern Med 2016; 55: 1511–1517.
3.
Morito Y, Aimi M, Ishimura N, Shimura S, Mikami H, Okimoto E, Sato S, Ishihara S, Kushiyama Y, Katsube T, Adachi K, Kinoshita Y: Association between sleep disturbances and abdominal symptoms. Intern Med 2014; 53: 2179–2183.
4.
Shaker R, Castell DO, Schoenfeld PS, Spechler SJ: Nighttime heartburn is an under-appreciated clinical problem that impacts sleep and daytime function: the results of a Gallup survey conducted on behalf of the American Gastroenterological Association. Am J Gastroenterol 2003; 98: 1487–1493.
5.
Jansson C, Nordenstedt H, Wallander MA, Johansson S, Johnsen R, Hveem K, Lagergren J: A population-based study showing an association between gastroesophageal reflux disease and sleep problems. Clin Gastroenterol Hepatol 2009; 7: 960–965.
6.
Fujiwara Y, Arakawa T, Fass R: Gastroesophageal reflux disease and sleep. Gastroenterol Clin North Am 2013; 42: 57–70.
7.
Jung HK, Choung RS, Talley NJ: Gastroesophageal reflux disease and sleep disorders: Evidence for a causal link and therapeutic implications. J Neurogastroenterol Motil 2010; 16: 22–29.
8.
Buchanan DT, Cain K, Heitkemper M, Burr R, Vitiello MV, Zia J, Jarrett M: Sleep measures predict next-day symptoms in women with irritable bowel syndrome. J Clin Sleep Med 2014; 10: 1003–1009.
9.
Kim HI, Jung SA, Choi JY, Kim SE, Jung HK, Shim KN, Yoo K: Impact of shiftwork on irritable bowel syndrome and functional dyspepsia. J Korean Med Sci 2013; 28: 431–437.
10.
Vege SS, Locke GR 3rd, Weaver AL, Farmer SA, Melton LJ 3rd, Talley NJ: Functional gastrointestinal disorders among people with sleep disturbances: a population-based study. Mayo Clin Proc 2004; 79: 1501–1506.
11.
Kim K, Uchiyama M, Okawa M, Liu X, Ogihara R: An epidemiological study of insomnia among the Japanese general population. Sleep 2000; 23: 41–47.
12.
Papadimitriou GN, Linkowski P: Sleep disturbance in anxiety disorders. Int Rev Psychiatry 2005; 17: 229–236.
13.
Drossman DA: The functional gastrointestinal disorders and the Rome III process. Gastroenterology 2006; 130: 1377–1390.
14.
Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC: Functional bowel disorders. Gastroenterology 2006; 130: 1480–1491.
15.
Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ: The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989; 28: 193–213.
16.
Hung HC, Yang YC, Ou HY, Wu JS, Lu FH, Chang CJ: The association between self-reported sleep quality and metabolic syndrome. PLoS One 2013; 8:e54304.
17.
Lei WY, Yu HC, Wen SH, Liu TT, Yi CH, Wang CC, Hsu CS, Chen CH, Chen CL, Pace F: Predictive factors of silent reflux in subjects with erosive esophagitis. Dig Liver Dis 2015; 47: 24–29.
18.
Shaw MJ, Talley NJ, Beebe TJ, Rockwood T, Carlsson R, Adlis S, Fendrick AM, Jones R, Dent J, Bytzer P: Initial validation of a diagnostic questionnaire for gastroesophageal reflux disease. Am J Gastroenterol 2001; 96: 52–57.
19.
Lee Y, Yang MJ, Lai TJ, Chiu NM, Chau TT: Development of the Taiwanese depression questionnaire. Chang Gung Med J 2000; 23: 688–694.
20.
Julian LJ: Measures of anxiety: State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), and Hospital Anxiety and Depression Scale-Anxiety (HADS-A). Arthritis Care Res (Hoboken) 2011; 63(suppl 11):S467–S472.
21.
Hossain JL, Shapiro CM: The prevalence, cost implications, and management of sleep disorders: an overview. Sleep Breath 2002; 6: 85–102.
22.
Doi Y, Minowa M, Uchiyama M, Okawa M: Sleep-medication for symptomatic insomnia in the general population of Japan. Sleep and Biological Rhythms 2005; 3: 149–157.
23.
Carabotti M, Scirocco A, Maselli MA, Severi C: The gut-brain axis: Interactions between enteric microbiota, central and enteric nervous systems. Ann Gastroenterol 2015; 28: 203–209.
24.
Khanijow V, Prakash P, Emsellem HA, Borum ML, Doman DB: Sleep dysfunction and gastrointestinal diseases. Gastroenterol Hepatol (N Y) 2015; 11: 817–825.
25.
Santos RV, Tufik S, De Mello MT: Exercise, sleep and cytokines: is there a relation? Sleep Med Rev 2007; 11: 231–239.
26.
Vgontzas AN, Bixler EO, Lin HM, Prolo P, Trakada G, Chrousos GP: Il-6 and its circadian secretion in humans. Neuroimmunomodulation 2005; 12: 131–140.
27.
Mody R, Bolge SC, Kannan H, Fass R: Effects of gastroesophageal reflux disease on sleep and outcomes. Clin Gastroenterol Hepatol 2009; 7: 953–959.
28.
Fujiwara Y, Kohata Y, Kaji M, Nebiki H, Yamasaki T, Sasaki E, Hayakawa T, Machida H, Tanigawa T, Watanabe K, Watanabe T, Tominaga K, Arakawa T: Sleep dysfunction in Japanese patients with gastroesophageal reflux disease: prevalence, risk factors, and efficacy of rabeprazole. Digestion 2010; 81: 135–141.
29.
Matsuki N, Fujita T, Watanabe N, Sugahara A, Watanabe A, Ishida T, Morita Y, Yoshida M, Kutsumi H, Hayakumo T, Mukai H, Azuma T: Lifestyle factors associated with gastroesophageal reflux disease in the Japanese population. J Gastroenterol 2013; 48: 340–349.
30.
Okuyama M, Takaishi O, Nakahara K, Iwakura N, Hasegawa T, Oyama M, Inoue A, Ishizu H, Satoh H, Fujiwara Y: Associations among gastroesophageal reflux disease, psychological stress, and sleep disturbances in Japanese adults. Scand J Gastroenterol 2017; 52: 44–49.
31.
Kim JY, Kim N, Seo PJ, Lee JW, Kim MS, Kim SE, Jo SY, Lee DH, Jung HC: Association of sleep dysfunction and emotional status with gastroesophageal reflux disease in Korea. J Neurogastroenterol Motil 2013; 19: 344–354.
32.
Dickman R, Green C, Fass SS, Quan SF, Dekel R, Risner-Adler S, Fass R: Relationships between sleep quality and ph monitoring findings in persons with gastroesophageal reflux disease. J Clin Sleep Med 2007; 3: 505–513.
33.
Miwa H, Minoo T, Hojo M, Yaginuma R, Nagahara A, Kawabe M, Ohkawa A, Asaoka D, Kurosawa A, Ohkusa T, Sato N: Oesophageal hypersensitivity in Japanese patients with non-erosive gastro-oesophageal reflux diseases. Aliment Pharmacol Ther 2004; 20(suppl 1): 112–117.
34.
Yarandi SS, Christie J: Functional dyspepsia in review: pathophysiology and challenges in the diagnosis and management due to coexisting gastroesophageal reflux disease and irritable bowel syndrome. Gastroenterol Res Pract 2013; 2013: 351086.
35.
Futagami S, Shimpuku M, Yamawaki H, Izumi N, Kodaka Y, Nagoya H, Wakabayashi T, Shindo T, Kawagoe T, Sakamoto C: Sleep disorders in functional dyspepsia and future therapy. J Nippon Med Sch 2013; 80: 104–109.
36.
Riehl ME, Keefer L: Hypnotherapy for esophageal disorders. Am J Clin Hypn 2015; 58: 22–33.
37.
Schey R, Dickman R, Parthasarathy S, Quan SF, Wendel C, Merchant J, Powers J, Han B, van Handel D, Fass R: Sleep deprivation is hyperalgesic in patients with gastroesophageal reflux disease. Gastroenterology 2007; 133: 1787–1795.
You do not currently have access to this content.