Sleep impairment in patients with ulcerative colitis: a cross-sectional assessment of clinical, inflammatory, metabolic and behavioral factors

Abstract Background Sleep impairment is common in ulcerative colitis (UC) and may persist during clinical remission. This study evaluated the clinical, inflammatory, metabolic, and behavioral features to better characterize the factors associated with poor sleep in patients with UC. Methods A cross-sectional study was performed including 22 patients with active UC, 28 with UC in remission, and 24 healthy controls. Disease activity was classified using partial and total Mayo scores with an endoscopic confirmation. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and a brief questionnaire on bedtime smartphone and social media use. At the time of study inclusion, comprehensive clinical, laboratory, and body composition assessments were performed. Results A total of 22 patients with active UC, 28 in remission, and 24 controls were included (mean age, 41.4 ± 14.3 years). Poor sleep quality (PSQI ≥ 5) was significantly more frequent in patients with UC (90.9% active, 85.7% remission) than in controls (33.3%; p < 0.001). Global PSQI scores were also higher in both active (7.4 ± 2.5) and remission UC (7.1 ± 2.9) than in controls (4.6 ± 1.7; p < 0.001), although the difference between active and remission was not significant. The mean BMI remained in the overweight range across all groups (≈ 25 kg/m², p = 0.887), and 25-OH vitamin D levels were low in every group (51.7–56.7 nmol/L, p = 0.727). Conclusion Sleep impairment is highly prevalent in patients with ulcerative colitis and persists even during clinical remission. Although inflammatory activity is likely a major contributor, metabolic and behavioral factors may also play a role. Routine assessment of sleep quality and targeted interventions may help improve symptom control and overall quality of life in UC.