Inflammatory Fatigue Case Study

Background:
Inflammatory bowel disease (IBD) is a non-curable chronic inflammatory condition that can affect any part of the gastrointestinal tract. Symptoms include diarrhea, nocturnal bowel movements, rectal bleeding, and abdominal pain. Nevertheless, even when the gastrointestinal symptoms are in clinical remission, fatigue can remain a dominant symptom and have a dramatically negative impact on quality of life for many patients. Recently we examined the prevalence of fatigue in our population of IBD patients attending the University of Alberta Gastronintestinal Clinic during 2013. We evaluated fatigue in 322 patients using the validated Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) measurement tool and identified that

53.7% of patients with IBD had severe fatigue. In this same study, 41.9% of patients reported some negative changes in sleep. Disease flares can contribute to sleep disturbance, however, previous reports have confirmed that 50% of patients with IBD in remission complain of poor sleep quality. Despite the status of disease remission, fatigue is a common complaint in patients with IBD. This background has led us to hypothesize that the fatigue seen in patients with IBD, who are in remission, relates to sleep disturbance.
Objectives:
(1) to determine the prevalence of sleep disturbance in the inflammatory bowel disease patient population reporting fatigue and (2) to understand the extent to which sleep deficiency is associated with fatigue.
Methodology:
This is a pilot study of patients with a known diagnosis of IBD, who are clinically in remission and self-report fatigue.

Polysomnography (PSG) will be used to evaluate sleep disturbance. To ensure eligibility, the study coordinator will go through a screening checklist. If at least one criterion is not met, the patient will be excluded from participating. If the participant meets eligibility criteria, they will be invited to participate and the phases of the study will be explained. Upon informed consent, demographic data will be collected from the patient or from the patient chart. Additionally, a fecal calprotectin kit will be administered to each participant to confirm remission status. To prepare for PSG, participants will be instructed to keep a 2-week sleep diary prior to overnight evaluation. Finally, participants will complete 3 questionnaires before their sleep appointment and submit them, along with the sleep diary: (1) Functional Assessment of Chronic Illness Therapy-Fatigue questionnaire; (2) Beck Depression Inventory-II; and (3) Pittsburgh Sleep Quality Index questionnaire. PSG will take place in a level-one sleep laboratory at the Edmonton General Continuing Care Centre. Following PSG observations, the data will be analyzed via statistical software to determine if the fatigue reported by patients with IBD is related to sleep

disturbance.
Future Directions:
My career goal is to become a health sciences researcher. I will do this by completing my master's degree, which includes managing all aspects of my project. I plan to progress into a PhD following my master's degree, wherein I hope to focus on the basic sciences branch of gastrointestinal health research. With my strong academic background and my passion for research, I have confidence that I will succeed in following this career plan.