Poor sleep and depression associated with higher incidence of peptic ulcer disease
A recent study by investigators from Hong Kong showed that poor sleep quality and longer sleep onset latency are associated with an increased risk of peptic ulcer disease (PUD) recurrence. Depression is also shown to be associated with subsequent incidence of PUD.
The multicentre, prospective study was conducted from January 2011 to October 2014 at eight hospitals in Guangdong, China and recruited 1,420 Helicobacter pylori-infected PUD patients aged ≥55 years who were followed up for 36 months. [J Am Geriatr Soc 2019, doi: 10.1111/jgs.15871]
PUD recurrence was determined via oesophagogastroduodenoscopy at 6-month intervals. Subjective sleep quality was measured using the Pittsburgh Sleep Quality Index. Objective sleep quality was measured using an accelerometer which assessed sleep onset latency, sleep efficiency, total sleep time, and number of awakenings.
Results from the study showed that participants who reported poorer sleep quality were more likely to experience PUD recurrence (hazard ratio [HR], 1.895; 95 percent confidence interval [CI], 1.008 to 3.327). Longer sleep onset latency (HR, 1.558; 95 percent CI, 1.156 to 2.278) and more night-time awakenings (HR, 1.697; 95 percent CI, 1.168 to 2.665) were also associated with an increased risk of PUD recurrence.
A longer total sleeping time was, however, shown to be protective against PUD recurrence (HR, 0.768; 95 percent CI, 0.699 to 0.885).
“Gastric mucosal blood flow accelerates ulcer healing and increases during rapid eye movement [REM] sleep. Individuals with longer sleep latency who cannot fall asleep within a reasonable amount of time may encounter impairment of this gastric mucosal protective mechanism,” the investigators explained.
Another study performed by the same group of investigators between May 2010 and May 2015, which recruited 2,850 elderly individuals (48 percent female; mean age, 69.8 years) from eight hospitals in Guangdong, China, revealed that the incidence of PUD was higher in depressed vs non-depressed participants (10.1 percent vs 5.3 percent). [J Psychosom Res 2019, doi: 10.1016/j.jpsychores.2019.04.002]
In participants with depression, increased or continued social engagement during follow-up reduced the incidence of PUD to 6.2 percent and 7.9 percent, respectively.
Moreover, depressed participants who reported decreased (HR, 2.485; 95 percent CI, 1.459 to 3.295) or no social engagement (HR, 2.896; 95 percent CI, 1.817 to 4.228) were more likely to develop PUD than those without depression.
“The study findings supplement existing knowledge that the cumulative incidence of PUD is higher among depressed than non-depressed patients, and that depression is a prominent predictor of subsequent PUD,” the investigators commented. [Medicine (Baltimore) 2015;94:e2333; J Psychosom Res 2013;75:121-127]
“Prolonged depression-related stress can interfere with normal functioning of the gut-brain axis by altering immune functioning of the gastrointestinal tract, thus potentially increasing gastrointestinal susceptibility to ulcerogenic agents such as H. pylori,” they explained.
The results of these two studies highlight the importance of properly treating and preventing sleep problems in older patients with documented PUD. The risk of PUD may also be decreased by increasing and maintaining engagement in social activities among the elderly.