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Re: MMR vaccine and autism - IBS

Posted by Alamo Joe on September 12, 2001 at 13:59:38:

In Reply to: Re: MMR vaccine and autism - Reflux posted by Alamo Joe on September 12, 2001 at 13:58:00:

Irritable Bowel Syndrome and Sleep disorders

The studies by Jarrett (1) and Kumar (2) into aspects of sleep in irritable bowel syndrome provide data critical to investigation the etiology of irritable bowel syndrome. This letter presents the hypothesis: “Irritable bowel syndrome is secondary to those sleep related breathing disorders which include in their characterization diaphragm movements which are more forceful than those during normal breathing.”

Kumar’s study (2) has information vital to establishing the association between obstructive sleep apnea and irritable bowel syndrome. That study reported that during a study of the ‘brain - gut axis’, three of six irritable bowel syndrome subjects were diagnosed with a sleep disturbance disorder, namely obstructive sleep apnea, but none of six controls subjects were diagnosed with sleep apnea. If a binomial distribution is used to evaluate the association between irritable bowel syndrome and obstructive sleep apnea with the following conditions: 1) The six irritable bowel syndrome subjects had the same prevalence for sleep apnea, 2) That the prevalence of sleep apnea (3) used in the calculation is least favorable (Based on gender and age) to establishing an association; the probability of a non-association of obstructive sleep apnea and irritable bowel syndrome is 0.0097, or an odds ratio of 100:1 that there is an association between the two disorders.

Although the above statistics indicate a strong association, those statistics do not indicate whether or not the association is due to a third disorder. Further those statistics can not identify primacy between the two disorders, even if that relationship does exist. However, Jarrett (1) points out that there is statistical significance between daytime bowel symptoms the quality of the previous’ night sleep. However, no significance was found, between daytime bowel symptoms and the following night’s sleep. This information indicates that irritable bowel syndrome is secondary to obstructive sleep apnea.

Focusing on the unique action of the diaphragm during apneas, this letter postulates that the additional effort exerted by the diaphragm during an apnea (4) is the mechanism by which intestinal performance is affected. During normal breathing the diaphragm displaces and/or compresses the contents of the abdomen. It is postulated that during apneas, these greater force diaphragm movements introduce intestinal trauma and thus deleteriously affect intestinal function. In essence, the diaphragm is ‘hitting below the belt’ from 5 (diagnostic lower limit) to over 100 times an hour. Because the extreme diaphragm action occurs every night, daytime healing is surmounted by the subsequent night’s sleep disturbances.

Note: While the above discussion was limited to obstructive sleep apnea, any sleep related breathing disorder which involves greater than normal diaphragm action (eg Upper airway resistance syndrome (5)) would produce appropriate intestinal trauma.

This post has presented evidence that sleep related breathing disorders cause irritable bowel syndrome.

1) Jarrett M; Heitkemper M; Cain KC; Burr RL; Hertig V. Sleep disturbance influences gastrointestinal symptoms in women with irritable bowel syndrome. Dig Dis Sci 2000 May;45(5):952-9

2) Kumar D; Thompson PD; Wingate DL; Vesselinova-Jenkins CK; Libby G. Abnormal REM sleep in the irritable bowel syndrome. Gastroenterology 1992 Jul;103(1):12-7

3) Ohayon MM; Guilleminault C; Priest RG; Caulet M. Snoring and breathing pauses during sleep: telephone interview survey of a United Kingdom population sample. BMJ 1997 Mar 22;314(7084):860-3

4) Guilleminault C. Obstructive Sleep Apnea The Clinical Syndrome and Historical Perspective. Medical Clinics of North America 69(6): 1187-1203

5) Guilleminault C; Stoohs R; Kim YD; Chervin R; Black J; Clerk A. Upper airway sleep-disordered breathing in women. Ann Intern Med 1995 Apr 1;122(7):493-501

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