Enhancement of REM Sleep in IBS Patients

Recently, several studies have shown an alteration in bowel function during sleep in patients with irritable bowel syndrome (IBS), and a recent study also suggests a remarkable increase in rapid eye movement (REM) sleep. These studies have suggested that an alteration in CNS function may play an important role in the pathogenesis of IBS.

The IBS group had a notable and significant increase in the percentage and duration of REM sleep. The control group had a decrease in the amplitude of the dominant EGG frequency from waking to non-REM sleep, and a subsequent increase in the amplitude from non-REM to REM sleep. No such changes were noted in the patients with IBS.

Rapid eye movement (REM) sleep is increased significantly in patients with IBS. Results have also shown REM sleep to be significantly increased in a group of women with IBS compared with a group of age and sex matched controls. In addition, a fundamental measure of intrinsic gastric functioning was found to be significantly altered during sleep when compared with controls.

With regard to the alterations in REM sleep, results and those of Kumar et al would have to be considered extraordinary. These studies represent the first description of any medical condition associated with an increase in the percentage of REM sleep. Parameters of REM sleep have been described extensively in depression.

For example, numerous studies have shown a decrease in the latency to the first REM period, as well as an increase in the percentage of REM sleep in the first half of the night without necessarily resulting in an overall increase in the percentage of REM sleep for the entire sleep period. Furthermore, the usual response to REM deprivation in the form of the rebound of REM sleep has been shown to be an accurate predictor of antidepressant treatment response.

On the other hand, schizophrenics seem to be somewhat impervious to alterations in REM sleep, but they fail to show the characteristic rebound of REM sleep subsequent to REM deprivation. These results are of particular interest in view of the numerous studies documenting the presence of psychological abnormalities, particularly depression, in patients diagnosed with IBS.

Thus, the fact that REM sleep is controlled by a variety of complex brain stem mechanisms, alterations in REM sleep associated with neuropsychiatric conditions such as depression and schizophrenia, and the notable increase in REM sleep in patients with IBS described in the present investigation would argue strongly in favour of some CNS dysfunction characterising patients with IBS.

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