Prevalence and Associated Factors of Insomnia in College Students with Irritable Bowel Syndrome

Yun-Yi Yang; Sangeun Jun

doi:10.7475/kjan.2018.30.3.235

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Yang and Jun: Prevalence and Associated Factors of Insomnia in College Students with Irritable Bowel Syndrome

Original Article

Korean J Adult Nurs 2018;30(3):235-244.

Published online: 21 June 2018

DOI: https://doi.org/10.7475/kjan.2018.30.3.235

Prevalence and Associated Factors of Insomnia in College Students with Irritable Bowel Syndrome

Yun-Yi Yang, Sangeun Jun

College of Nursing, Keimyung University, Daegu, Korea

Corresponding author: Jun, Sangeun https://orcid.org/0000-0002-1988-0357 College of Nursing, Keimyung University, 1095 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Korea. Tel: +82-53-580-3923, Fax: +82-53-580-3916, E-mail: sejun2@kmu.ac.kr

Received 3 February 20182 April 2018 Accepted 13 May 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to identify factors associated with insomnia in college students with Irritable Bowel Syndrome(IBS).

Methods

College students with IBS(n=259) were recruited in 4 universities in Daegu city and Ulsan city, South Korea. Participants completed questionnaires measuring the following variables: insomnia (Insomnia Severity Index [ISI]), dysfunctional beliefs and attitudes about sleep (Dysfunctional Beliefs and Attitudes about Sleep Scale-16 [DBAS-16]), pre-sleep arousal (Pre-Sleep Arousal Scale [PSAS]), gastrointestinal symptoms during sleep(Gastrointestinal Symptoms during Sleep), sleep hygiene(Sleep Hygiene Practices Scale [SHPS]), psychological distress(Brief Symptom Inventory-18 [BSI-18]), and IBS symptom severity(IBS Severity Scoring System [IBS-SSS]).

Results

In our participants, 53.3%(n=138) reported having insomnia (ISI score ≥10). Compared to the non-insomnia group(n=121), the insomnia group reported significantly higher scores in DBAS-16, PSAS, gastrointestinal symptoms during sleep, IBS-SSS, SHPS, and BSI-18 (p＜.001 for all). Multiple logistic regression analysis revealed that gastrointestinal symptoms during sleep (Odds Ratio [OR]=2.77, 95% Confidence Interval [CI]: 1.29~ 5.96), dysfunctional beliefs and attitudes about sleep(OR=1.04, 95% CI: 1.03~1.06), cognitive arousal before sleep (OR=1.10, 95% CI: 1.05~1.17), and somatization (OR=1.12, 95% CI: 1.02~1.23) were associated with insomnia in this sample.

Conclusion

Our findings indicate that insomnia is a serious problem for college students with IBS and that gastrointestinal symptoms during sleep and sleep related dysfunctional cognitions should be managed to improve insomnia of them.

Keywords: Irritable bowel syndrome, Insomnia, Pre-sleep arousal

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Table 1.

Comparison of Demographic and Clinical Characteristics between Insomnia and Non-insomnia Groups (N=259)

Variables	Categories	Total (n=259)	Insomnia		x² or t	p
		Total (n=259)	Yes (n=138)	No (n=121)
		n (%) or M± SD	n (%) or M± SD	n (%) or M± SD
Age (year)		20.62±1.89	20.69±1.73	20.55±1.79	-0.61	.545
Gender	Men	32 (12.4)	18 (13.0)	14 (11.6)	0.13	.719
Gender	Women	227 (87.6)	120 (87.0)	107 (88.4)
Grade	Freshman	82 (31.7)	46 (33.3)	36 (29.8)	2.06	.553
	Sophomore	76 (29.3)	36 (26.1)	40 (33.1)
	Junior	86 (33.2)	49 (35.5)	37 (30.6)
	Senior	15 (5.8)	7 (5.1)	8 (6.6)
IBS subtypes	Constipation-predominant	20 (7.7)	7 (5.1)	13 (10.7)	3.23	.367^†
	Diarrhea-predominant	28 (10.8)	16 (11.8)	12 (9.9)
	Mixed	203 (78.4)	109 (80.1)	94 (77.7)
	Unclassified	6 (2.3)	4 (2.9)	2 (1.7)
Current smoking	Yes	20 (7.7)	13 (9.4)	7 (5.8)	1.20	.274
Current smoking	No	239 (92.3)	125 (90.6)	114 (94.2)
Dysfunctional beliefs and attitudes about sleep		77.20±25.08	89.52±22.30	63.14±20.27	-9.91	.001
Dysfunctional beliefs and attitudes about sleep
Pre-sleep arousal	Total	36.60±12.74	42.51±12.56	29.85±9.10	-9.36	.001
	Somatic arousal	16.58±6.92	19.14±7.45	13.66±4.87	-7.09	.001
	Cognitive arousal	20.19±7.80	23.84±7.55	16.03±5.75	-9.43	.001
GI symptom during sleep	Yes	74 (29.0)	59 (42.8)	16 (13.2)	27.33	.001
GI symptom during sleep	No	184 (71.0)	79 (57.2)	105 (86.8)
IBS symptom severity		278.85±77.46	302.46±71.12	251.93±75.85	-5.53	.001
Sleep hygiene	Total	82.90±19.19	91.46±18.43	73.12±14.95	-8.72	.001
	Arousal-related behaviors	31.08±7.15	33.98±6.84	27.77±5.96	-7.73	.001
	Sleep scheduling and timing	22.12±6.05	24.76±5.87	19.31±4.84	-8.10	.001
	Eating and drinking behaviors	11.96±4.24	12.87±4.50	10.93±3.67	-3.83	.001
	Sleep environment	17.65±7.65	20.02±8.18	14.93±5.97	-5.77	.001
Psychological distress	Total	20.44±13.86	26.24±13.87	13.84±10.52	-8.16	.001
	Somatization	6.31±4.86	8.43±4.98	3.90±3.40	-8.63	.001
	Depression	8.13±9.99	10.50±12.51	5.44±4.67	-4.20	.001
	Anxiety	6.57±5.10	8.38±5.32	4.50±3.95	-6.70	.001
Insomnia severity score		9.96±5.65	14.24±3.80	5.05±2.58	-23.00	.001

IBS=irritable bowel syndrome; GI=gastrointestinal;

^† Fisher's exact test.

Table 2.

Predictors of Insomnia among College Students with Irritable Bowel Syndrome (N=259)

Variables	Categories	B	SE	OR	95%	% CI	p
Variables	Categories	B	SE	OR	Lower	Upper	p
GI symptom during sleep		1.02	0.39	2.77	1.29	5.96	.009
Dysfunctional beliefs and attitudes about sleep		0.41	0.01	1.04	1.03	1.06	.001
Pre-sleep arousal	Cognitive arousal	0.10	0.03	1.10	1.05	1.17	.001
Psychological distress	Somatization	0.11	0.05	1.12	1.02	1.23	.018
		-2Log Likelihood=227.64, Hosmer and Lemeshow test: x²=7.01, p=.536,
		Nagelkerke R²=.528, correct classification (%)=78.4%

SE=standard error; OR=odds ratio; CI=confidence interval; GI=gastrointestinal.

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