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.
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