Sleep disturbances in inflammatory bowel disease: mechanisms, clinical consequences, and therapeutic implications

Background. Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, is commonly associated with sleep disturbances and fatigue. Sleep disruption interacts bidirectionally with immune and neuroendocrine pathways, affecting disease activity, relapse risk, and long-term outcomes. Aim. This review synthesizes current evidence on the relationship between sleep disturbances and IBD, focusing on pathophysiological mechanisms, clinical correlations, and prognostic and therapeutic implications. It evaluates whether sleep disorders are secondary to inflammation or independent contributors to disease progression, supporting the integration of sleep assessment into IBD care. Material and methods. A narrative review of studies published between 2000 and 2025 was conducted using PubMed and Scopus. Search terms included “inflammatory bowel disease”, “Crohn’s disease”, “ulcerative colitis”, “sleep”, “circadian rhythm”, “fatigue”, and “cytokines”. Included were clinical and preclinical studies, systematic reviews, and meta-analyses addressing sleep and inflammatory mechanisms in IBD. Selection was based on relevance and methodological quality. Results. Pro-inflammatory cytokines (IL-1, IL-6, TNF-α) regulate NREM sleep, while their chronic elevation in IBD contributes to sleep fragmentation and systemic inflammation. Sleep deprivation worsens intestinal barrier function via ER stress in goblet cells, increasing mucosal inflammation. Dysregulation of the HPA axis and leptin signaling further enhances immune activation. Poor sleep correlates with subclinical inflammation, higher relapse risk, fatigue, and long-term complications. Psychological comorbidities and pharmacotherapy additionally influence sleep quality. Conclusions. Sleep disturbances are common in IBD, mechanistically linked to its pathophysiology, and impact disease course. Routine sleep assessment and targeted interventions may improve quality of life and potentially modify outcomes.