Assess the characteristics of patients who experience pleasant sleep during preparation for a colonoscopy

A multicenter, cross-sectional study was conducted in adult patients with an indication for colonoscopy. Face-to-face questionnaires used dichotomous (yes/no) questions to assess five specific variables of sleep quality during preparation: (1) whether the patient fell asleep easily, (2) trouble staying asleep, (3) avoidance of nighttime bathroom visits, (4) more than 7 hours of sleep, and (5) waking up feeling rested. Patients who reported no disturbances in any of these five variables were defined as having good sleep quality. Also, the Hospital Anxiety and Depression (HAD) Scale was administered. A multivariate logistic regression analysis was performed to identify characteristics of patients with good sleep quality.

Of 316 patients, 195 were female (61.7%). The average age was 50 ± 14 years. Pleasant sleep, meeting all five assessed variables, was reported by 32 patients (10.13%).

Patients more likely to sleep over 7 hours included those younger than 50 years old (OR=1.923, CI=1.196-3.091, p=0.007), alcohol consumption (OR=3.165, CI=1.013-9.888, p=0.044), and hemorrhoidal disease (OR=1.687, CI=0.999-2.851, p=0.049). However, those who were over 50 years of age (OR=0.542, CI=0.346-0.850, p=0.007), consumed NSAIDs (OR=0.394, CI=0.162-0.956, p=0.034), were constipated (OR=0.468, CI=0.292-0.750, p=0.001), or had anxiety per HAD (OR=0.233, CI=0.049-1.097, p=0.047) were less likely to sleep over 7 hours. Difficulty waking up rested was more common in patients with elementary education, constipation, Bristol stool scores of 1–2, and use of specific PEG solutions. Those who woke up feeling rested had a diagnosis of hypothyroidism and were taking levothyroxine. In the multivariate analysis, those with elementary education (OR=4.194, [CI=1.036-16.985], p=0.045) continued to feel rested upon waking. Difficulty falling asleep was associated with nephropathy (OR=14.068, [CI=1.055-187.582], p=0.045), NSAID use (OR=2.430, [CI=1.018-5.789], p=0.045), and PEG without sodium metabisulfite (OR=2.222, [CI=1.100-4.492], p=0.026). However, those who were obese (OR=0.344, [CI=0.157-0.756], p=0.008) were less likely to have difficulty falling asleep. Trouble staying asleep was linked to patients with middle school education (OR=3.525, [CI=1.069-11.623], p=0.038), although those who took the preparation cold (OR=0.559, [CI=0.350-891], p=0.015) and those with hemorrhoidal disease (OR=0.467, [CI=0.264-0.824], p=0.009) did not show trouble staying asleep. Nighttime bathroom visits were more common among patients aged 50 or older, with diabetes, prior abdominal surgery, diverticular disease, and the use of PEG containing sodium metabisulfite; meanwhile, PEG without sodium metabisulfite showed fewer nighttime bathroom visits. Only prior abdominal surgery (OR=2.073, [CI=1.244-3.455], p=0.005) was the only characteristic that persisted in the multivariate analysis.

Only a minority of patients reported pleasant sleep during bowel preparation. Sleep disturbances were more common in individuals with obesity, nephropathy, NSAID use, prior abdominal surgery, and lower educational attainment. Notably, consuming the preparation cold was independently associated with fewer sleep disruptions, particularly reduced difficulty staying asleep; this finding aligns with a recent population-based study demonstrating that beverage and food temperatures can influence sleep and gut health (Tianying Wu et al.). Incorporating cold bowel preparation may therefore represent a simple, practical strategy to improve sleep quality and overall tolerability of the preparation regimen