Sleep Effect on Gastrointestinal Health and Disease: Translational Opportunities for Promoting Health and Optimizing Disease Management

David A. Johnson, M.D. (Editor)
Department of Internal Medicine, Chief, Division of Gastroenterology, Eastern Virginia Medical School, Norfolk, VA, US

William C. Orr, Ph.D. (Editor)
Lynn Health Science Institute, Clinical Professor of Medicine, University of Oklahoma Health Sciences Center, OK, US

J. Catesby Ware, Ph.D. (Editor)
John and Lillian Norfleet Professor in Internal Medicine, Chief, Division Sleep Medicine, Eastern Virginia Medical School, VA, US

Parth J. Parekh, M.D. (Editor)
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Carilion Clinic, Virginia Tech School of Medicine, Roanoke, VA US

Edward C. Oldfield, M.D. (Editor)
Internal Medicine, Eastern VA Medical School Norfolk, VA, US

Series: Sleep – Physiology, Functions, Dreaming and Disorders
BISAC: HEA043000

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Special issue: Resilience in breaking the cycle of children’s environmental health disparities
Edited by I Leslie Rubin, Robert J Geller, Abby Mutic, Benjamin A Gitterman, Nathan Mutic, Wayne Garfinkel, Claire D Coles, Kurt Martinuzzi, and Joav Merrick

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Sleep disorders are abnormal sleep patterns and physiological changes that affect health. Over one third of Americans experience chronic sleep disturbance which contributes to numerous health conditions including: Cardiovascular and respiratory disease, depression, chronic pain syndromes, gastrointestinal diseases and decreased quality of life, among others. Chronic sleep deprivation is an epidemic that can have cumulative neurocognitive effects and exacerbate a broad array of common chronic diseases including obesity, hypertension, diabetes, stroke and coronary artery disease.

The effect on gastrointestinal health and disease is profound, albeit typically not recognized or addressed by clinicians. Dysfunctional sleep has been identified in a wide array of GI diseases affecting both visceral and hepatic disease, with both inflammatory and neoplastic induction.

Sleep and the GI system have a dynamic bidirectional relationship, effecting a complex balance of circadian rhythms, neurohumoral transmitters and the intestinal microbiome. The resultant effects of this interplay between sleep and GI health/disease is often difficult to define, however, a primary sleep disorder may be exacerbated by a GI disease, such as GERD, or a GI disease such as IBD may be the primary underlying cause of a sleep disorder. Regardless, there is emerging recognition that sleep and GI health may represent new targets for disease intervention. This includes the identification of genomic changes where gene products may be potential therapeutic targets. Additionally, epigenetic changes related to the environment can enhance the transcriptional activity of important genes. Also, clearly the intestinal microbiome is a discovery field for microbial products and activated immune cells that may translocate to the periphery and respond to manipulation. This relationship with sleep is another new horizon of recognition.

As these relationships between sleep and GI health have been identified, these findings are logical targets for intervention. As such, a keen and insightful awareness is necessary to maintain good health, or assessing symptoms of a disease state. Thus, the recognition of sleep disorders, and appropriate sleep directed management can help optimize the treatment of numerous gastrointestinal diseases.

Clearly, people need to recognize that sleep is not just a “placeholder” of dark time between two periods of daylight activity. Rather, assessing and promoting good sleep should be a “health mandate” for maintaining and regulating normal GI physiologic health, or mitigating sleep directed disease management strategies to optimize patient outcomes. Therefore, sleep dysfunction, should be a routine focus of all care providers, recognizing the importance of good sleep for promoting health and sleep disorders in perpetuating disease.
It is the meaningful intent of the authors of this treatise to increase the appropriate awareness of the invaluable role of sleep. Clearly, it is time for us all to open our eyes and realize the value of closing them.

David A Johnson MD MACG FASGE FACP
J. Catesby Ware PhD FAASM
Parth Parekh MD
Edward C. Oldfield IV MD
William Orr PhD FACG

Preface

Chapter 1. Physiologic Regulation of Sleep and Health
(J. Catesby Ware, PhD, John and Lillian Norfleet Professor in Internal Medicine, Chief, Division Sleep Medicine, Eastern Virginia Medical School, Norfolk, VA, USA)

Chapter 2. Sleep, Immune Function, and the Gut Microbiome: Pathophysiologic Translational Implications
(Larry D. Sanford, PhD and Richard P. Ciavarra, PhD, Sleep Research Laboratory, Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk VA, USA, and others)

Chapter 3. Sleep and Circadian Rhythms: Implications for Gastrointestinal Health
(Christopher B. Forsyth, PhD, Robin M. Voigt, PhD, Faraz Bishehsari, MD, PhD, Garth R Swanson, MD, Heather Rasmussen, PhD, Ali Keshavarzian, MD, Department of Internal Medicine, Division of Digestive Diseases and Nutrition, Section of Gastroenterology, Rush University Medical Center, Chicago, IL, USA, and others)

Chapter 4. Sleep Dysfunction and Effects on the Gut Microbiome: Clinical Implications
(Edward C. Oldfield IV, MD, Maurice S. Marcuard, MD, Will R. Takakura, MD, and David A. Johnson, MD, Department of Internal, Cedars-Sinai Medical Center, Los Angeles, CA, USA, and others)

Chapter 5. Sleep Dysfunction: Definitions and Prevalence
(Vishant Ramadorai, MD and David A. Johnson, MD, Department of Medicine, University of Virginia Medical Center, Charlottesville, VA, USA)

Chapter 6. Assessment of Sleep in Clinical Practice
(William C. Orr, PhD and Samih Raad, MD, President Emeritus, Lynn Health Science Institute, Clinical Professor of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA, and others)

Chapter 7. Sleep Dysfunction and Gastroesophageal Reflux Disease: Beyond Heartburn
(Edward C. Oldfield IV, MD, Ross C. D. Buerlein, MD, and David A. Johnson, MD, Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA, and others)

Chapter 8. Sleep, Autonomic Dysfunction and Irritable Bowel Syndrome (IBS)
(Minjeong Christine Kwon, MD and Eamonn M M Quigley, MD, Department of Medicine and Lynda K and David M Underwood Center for Digestive Disorders, Division of Gastroenterology and Hepatology, Houston Methodist Hospital and Weill Cornell Medical College, Houston, TX, USA)

Chapter 9. Sleep Dysfunction and Inflammatory Bowel Disease
(M. Anthony Sofia, MD, Michael Andersen, MD, and David T. Rubin, MD, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago Medicine, Chicago, IL, USA)

Chapter 10. The Role of Sleep Dysfunction in the Pathogenesis of Obesity and Metabolic Disease
Parth J. Parekh, MD, Saamia Faruqui, MD, Eric Montminy, MD, Katherine Boland, MD, and Luis A. Balart, MD, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Carilion Clinic, Virginia Tech School of Medicine, Roanoke, VA, USA, and others)

Chapter 11. Sleep Dysfunction and Liver Disease
(Parth J. Parekh, MD, Patrick Chang, Alex Sarkisian, MD, Molly Delk Plummer, MD, and Luis A. Balart, MD, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Carilion Clinic, Virginia Tech School of Medicine, Roanoke, VA, USA, and others)

Chapter 12. Sleep Dysfunction in Gastrointestinal Malignancy
(Jennifer Copare , Danielle M Pastor, PhD, Adebisi Alimi, MD, David A. Johnson, MD, Albany Medical Center, Albany, NY, USA, and others)

Chapter 13. Sleep, Critical Illness, and Gastrointestinal Disease: Exploring the Connection
(Mit P. Patel, MD, Joshua M. Sill, MD, Edward C. Oldfield IV, MD and David A. Johnson, MD, Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA, and others

Chapter 14. Good Sleep and Good Health
(Kellie R. Jones, MD and William C. Orr, PhD, Associate Professor of Medicine, Pulmonary, Critical Care, and Sleep Medicine, University of Oklahoma Health Sciences Center, Oklahoma City VA Healthcare System, Oklahoma City, OK, USA, and others)

Chapter 15. Non-Pharmaceutical Therapies for Sleep Dysfunction and Gastrointestinal Health
(Skye Ochsner Margolies, PhD, and John L. Schwartz, Jr., Assistant Professor, Division of Sleep Medicine, Eastern VA Medical School, Norfolk, VA, USA, and others)

Index

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