Associations between multidimensional sleep health and inflammatory bowel disease onset and activity: A systematic review of the RU-SATED framework

Abstract

BACKGROUND

Inflammatory bowel disease (IBD) is a relapsing-remitting disorder affecting approximately 3.8 million people worldwide. Sleep disturbances are highly prevalent in patients with IBD, with a prevalence of up to 60%. Previous systematic reviews have shown that sleep quality is significantly poorer in patients with IBD than in healthy individuals and worsens during active disease. However, the associations of other sleep dimensions with IBD onset and activity status remain unclear.

AIM

To investigate the associations of sleep duration, efficiency, timing, regularity, and alertness with IBD onset and activity.

METHODS

The protocol was registered with PROSPERO (CRD420261301771). PubMed, Cochrane Library, EMBASE, and PsycINFO were searched from inception to January 16, 2026. Studies were grouped by sleep dimensions, assessment method (subjective or objective) and comparison type (IBD vs controls; active vs inactive). Risk of bias was assessed using the Newcastle-Ottawa Scale. A narrative synthesis was conducted following the Synthesis Without Meta-analysis guideline, and evidence certainty was graded as strong, moderate, limited, conflicting, or insufficient using the best evidence synthesis approach.

RESULTS

Of 644 initially identified records, 23 studies were ultimately included, including 17 cross-sectional, 4 cohort, and 2 case-control studies. These studies assessed sleep duration (n = 18), efficiency (n = 13), timing (n = 4), regularity (n = 2), and alertness (n = 4). Moderate-level evidence showed that sleep duration under 6 hours per day was associated with a higher risk of incident IBD (hazard ratios 1.17 to 1.36, 95%CI 1.05 to 1.59). Objectively measured sleep duration did not differ significantly between active and inactive status. Limited evidence indicated that objectively measured sleep duration and efficiency did not differ significantly between patients with IBD and healthy controls. Subjectively assessed sleep duration, sleep efficiency, and chronotype distribution did not differ significantly between active and inactive IBD, whereas patients with active disease exhibited more severe daytime sleepiness. For most sleep dimensions, the evidence remained limited or conflicting.

CONCLUSION

The association between sleep health and IBD is multidimensional and complex. Evidence for most sleep dimensions remains limited or conflicting, precluding definitive conclusions about the overall impact of sleep health on IBD. Large-scale, prospective studies are needed to clarify these associations and inform clinical management.

Keywords: Inflammatory bowel disease; Sleep health; Sleep duration; Sleep efficiency; Sleep timing; Sleep regularity; Alertness; Chronotype; Social jetlag; Sleep midpoint

Core Tip: Sleep disturbance is a highly prevalent comorbidity in inflammatory bowel disease that affects disease course. This study systematically evaluated multidimensional sleep indicators in relation to disease onset and activity of inflammatory bowel disease. It reveals that short sleep increases disease risk, yet objectively measured sleep duration does not differ between active and inactive stages. However, substantial methodological heterogeneity precludes definitive conclusions for most sleep dimensions. High-quality, standardized prospective studies are needed to clarify these associations and inform clinical management.