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• W2409712904 abstract "The relationship between sleep disturbance and various upper or lower gastrointestinal (GI) disorders are complex and poorly understood. The relationship seems to be bidirectional: sleep impairment has been associated with altered GI function and exacerbations of GI symptoms, and these bothersome GI symptoms may also induce or aggravate sleep dysfunction. Notably, sleep disturbance has been associated with several “functional” GI disorders, such as gastroesophageal reflux disease (GERD), functional dyspepsia (FD), and irritable bowel syndrome (IBS) [1]. GERD patients can be woken by gastroesophageal reflux, which helps to facilitate esophageal clearance and symptom relief through positional change or the use of acute antireflux medication. However, night time awakening disrupts sleep and impairs overall sleep quality, leading to daytime sleepiness and reduced work productivity the next day [2]. Furthermore, the associated frequent sleep deprivation, emotional instability, and psychosocial comobidities could also induce visceral hypersensitivity, hyperalgia, and hypervigilance and contribute to the symptomatology in patients who suffer from these functional GI disorders [3]. In a recently published large-scale study enrolling 2936 individuals for an annual health examination, Morito et al [4] found that 233 (7.9%), 254 (8.6%), and 528 (18%) had GERD-, FD- and IBS-like symptoms, respectively, after excluding those with organic GI diseases. The severity of daytime sleepiness, in terms of Epworth Sleepiness Scale scores, in the individuals with GERD-, FD- and IBS-like symptoms were significantly higher than those observed in the asymptomatic individuals. Moreover, the presence of FD- and IBS-like symptoms were found to be significant influencing factors for sleep disturbances. Similarly, disruption of circadian rhythm due to rotating shift work (RSW) in some specific populations, such as hospital nurses or pilots on international flights, has been associated with various IBS-like symptoms, such as abdominal pain, constipation, and diarrhea. Therefore, RSW workers have become suitable study participants for researchers to explore the interesting roles of circadian rhythm and sleep in the pathogenesis of GI dysfunction and related symptoms. In a study enrolling 58 rotating shift and 60 regular day nurses, the authors found that functional GI disorders were more common and severe among rotating shift nurses. The symptom score was positively and independently correlated with the sleep disturbance score, suggesting that poor sleep might be associated with increased functional GI symptoms in rotating shift nurses [5]. In another study enrolling 399 nurses, rotating shift nurses (n = 75) also had a significantly higher prevalence of IBS, as defined by the update Rome III criteria, compared with day shift nurses (48% vs. 31%) [6]. However, sleep disturbances could not completely account for the association between shift work and the occurrence of IBS symptoms in that study. Therefore, melatonin, an important factor in regulating the circadian rhythm and modulating visceral sensitivity, has been used to improve bowel symptoms in female IBS patients, independent of its effects on sleep, in a double-blind placebo-controlled study [7]. Although the precise mechanism underlying these interesting associations between altered circadian rhythm, sleep disturbance, and functional GI disorders remains unclear, these aforementioned studies have highlighted the crucial roles of both enhanced visceral perception and GI dysmotility among the complex pathophysiology, and encourage further related studies. In this journal, Hung et al have evaluated objective anorectal manometry parameters, heart rate variability, subjective sleep questionnaires, and depression/anxiety questionnaires in 16 RSW workers and 11 control study participants without GI symptoms [8]. The authors successfully demonstrated that circadian rhythm disruption due to RSW was highly associated with altered anorectal motility, greater sleep disturbance, and depression. Their findings confirm that RSW workers are more vulnerable to anorectal dysfunction, which may be related to vagal activity disturbance and further impair bowel function and predispose them to constipation. In addition, a lower sensory threshold for anorectal balloon distension was found in RSW workers, which was also consistent with previous studies showing the enhanced visceral perception in people with poor sleep [9]. Studies from the same group of researchers also suggest that poor sleep may predispose a previously healthy individual to constipation, and sleep disturbances per se could be a potential pathogenic factor in constipation [10]. Similar to other studies enrolling shift work nurses [11], the authors have observed a cardiac autonomic dysregulation toward sympathetic balance, characterized by a noninvasive heart rate variability analysis in RSW workers. These findings suggest an increased risk of long-term sympathetic hyperactivity with probable clinical impact on the cardiovascular system as well as mental health. Early detection of the physical dysfunction and early intervention to prevent long-term complications for this high-risk group of RSW workers are warranted. Although the sample size in the present study was relatively small, the authors are to be commended for their rigorous exploration of the complex relationship between circadian rhythm disruption, sleep disturbance, and altered anorectal motility. With the advent of medical technology in recent decades, there are several technical aspects which may be refined in future studies on sleep dysfunction and alterations in GI motility. Firstly, high resolution anorectal manometry, which has closely spaced water-perfused or solid-state pressure sensors, demonstrates much better spatiotemporal pressurization than traditional nonhigh-resolution manometry systems and thus may provide a comprehensive assessment of anorectal physiology and coordinated activity in RSW workers or patients who suffer from sleep disturbances [12]. Secondly, studies of GI motility during sleep are difficult because of a lack of suitable methodology. In a recently published report using a novel ambulatory telemetric capsule system in conjunction with polysomnography (PSG), GI motility was concurrently investigated during sleep in nine healthy individuals [13]. This three-dimensional (3D) transit system consists of ingestible electromagnetic capsules which could be traced through a portable extracorporeal receiver while moving in the GI tract. Parameters of the GI contractions and the sleep depth could be easily obtained and correlated. Therefore, further studies with the application of the novel ambulatory 3D-transit system may allow a minimally invasive and completely ambulatory investigation of associations between disrupted sleep and GI dysmotility in the target population. Finally, current objective assessments of sleep quality primarily rely on the PSG. However, application of the PSG in clinical studies with a large sample size has been limited by its much higher cost, and facility-based and time-consuming nature. Recently, cardiopulmonary coupling sleep spectrogram analysis, derived from a continuous electrocardiography (ECG) recording, has been developed to quantify the objective features of sleep stability [14]. Compared with electroencephalography-based PSG, such an ECG-based approach has been found to be more user-friendly and cost-efficient, and can provide clinically useful insight into abnormal sleep in various patient populations [15]. Using the ECG-based cardiopulmonary coupling technique to evaluate the objective sleep parameters, Chien et al [16] demonstrated poor sleep quality among 156 female hospital nurses (32.3% had > 1 work shift/wk during the previous month), of whom up to 39.8% had inadequate sleep stability while 75.8% reported poor sleep quality scored by the Pittsburgh Sleep Quality Index. Nevertheless, neither subjective nor objective parameters of sleep quality were related to shift work in that study. In the future, studies with a prospective design, a larger sample size, and a comprehensive evaluation of sleep quality and GI function with up-to-date medical technology may provide a clinically useful insight into the complex interaction between sleep disturbance and GI dysfunction, and pave the way for better management of sleep disturbances and functional GI disorders. All authors declare no conflicts of interest." @default.
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• W2409712904 title "Altered circadian rhythm, sleep disturbance, and gastrointestinal dysfunction: New evidence from rotating shift workers" @default.
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