Authors: Abdurrahman Mohammed Hakami , Faisal Mohammed Jathmi , Shaher A. Awaji , Nwaf Yahya Mokeli , Salah Addin Shawani , Haifa Abdullah Alfaifi , Mohammed Abdullah Najmi , Abdulmajeed Mohammed Asiri , Turki Ebrahim Otayf , Sarah M. Khered , Sawsan Balhoul Hakami , Abdulrahman Abdullah Alghamdi , Erwa Elmakki , Abuobaida Yassin , Sami Alrasheedi ,

Abstract

Background: Poor sleep and gastrointestinal symptoms are each common in the general population. Studies from Korea, Japan and Norway link the two conditions, but the mechanism remains unclear, and no data exist from an Arab population.

Methods: This cross-sectional, community-based study surveyed adults aged 18 years and above in the Jazan region, Saudi Arabia. Sleep quality was measured with the Pittsburgh Sleep Quality Index, and gastrointestinal symptoms with the Gastrointestinal Symptom Rating Scale. Rome IV screening items and the PHQ-4 were also administered. Associations were tested by multivariable logistic regression.

Results: Of 422 responses submitted, 416 were analysed. Poor sleep quality affected 88 participants (21.15%, 95% CI 17.50–25.33). Mean Gastrointestinal Symptom Rating Scale total score was 1.48 (SD 0.29). Each standard deviation increase in this score raised the adjusted odds of poor sleep by 84% (OR 1.84, 95% CI 1.35–2.50, p<.001). Abdominal pain carried the strongest cluster association (OR 1.79), not reflux (OR 1.44). Nocturnal gastrointestinal symptoms showed complete separation from the outcome; all 10 participants woken weekly by a gastrointestinal symptom were poor sleepers (Firth-penalised OR 29.18, p=.002). Adding PHQ-4 attenuated the primary estimate by only 5.92%, and PHQ-4 was not independently associated with poor sleep (OR 1.10, 95% CI 0.85–1.42, p=.462).

Conclusion: Gastrointestinal symptom burden is independently associated with poor sleep quality among Jazan adults. This link runs mainly through symptom severity and nocturnal waking, not psychological distress.

Keywords: Gastrointestinal diseases, irritable bowel syndrome, Saudi Arabia, sleep quality, sleep-wake disorders, surveys and questionnaires.