Long-term risk of bowel resection and mortality associated with sleep behaviours and sleep pattern in patients with inflammatory bowel disease: a large-scale prospective cohort study.
Zhang Q, Xu F, et al. • Family medicine and community health • 2026
A healthy sleep pattern, particularly sleep duration and early chronotype, is associated with reduced all-cause mortality risk in patients with IBD, with probably beneficial effect on lowering risk of bowel resection, highlighting the importance of maintaining healthy sleep behaviours for long-term prognosis in IBD.
Key Findings
Results
Both healthy and intermediate sleep patterns were associated with reduced all-cause mortality risk compared to poor sleep pattern in IBD patients.
Healthy sleep pattern (score 4-5) was associated with HR=0.75 (95% CI 0.59 to 0.94) for all-cause mortality
Intermediate sleep pattern (score 3) was associated with HR=0.77 (95% CI 0.66 to 0.95) for all-cause mortality
A dose-response relationship was observed across sleep scores (HR=0.89, 95% CI 0.82 to 0.98 per unit increase in sleep score)
During a median 14.6-year follow-up, 498 deaths developed among 4262 IBD patients
Results
Appropriate sleep duration (7-8 hours per day) was associated with a 21% lower all-cause mortality risk in IBD patients.
HR=0.79 (95% CI 0.66 to 0.95) for appropriate sleep duration
Sleep duration of 7-8 hours per day was one of five low-risk sleep behaviours included in the sleep score
Analysis was conducted using multivariable Cox proportional hazards models
Results
Early chronotype was associated with an 18% lower all-cause mortality risk in IBD patients.
HR=0.82 (95% CI 0.68 to 0.98) for early chronotype
Early chronotype was one of five low-risk sleep behaviours included in the composite sleep score
This finding was independent of other sleep behaviours in multivariable analysis
Results
Never or rarely experiencing insomnia symptoms was associated with a 22% lower risk of bowel resection in IBD patients.
HR=0.78 (95% CI 0.65 to 0.94) for never/rarely insomnia symptoms and bowel resection risk
793 bowel resections occurred during the median 14.6-year follow-up among 4262 IBD patients
This was the only individual sleep behaviour with a statistically significant association with bowel resection risk
Results
Healthy and intermediate sleep patterns showed only marginally significant lower risk of bowel resection compared to poor sleep pattern.
Healthy sleep pattern: HR=0.86 (95% CI 0.72 to 1.04) for bowel resection — confidence interval crosses 1.0
Intermediate sleep pattern: HR=0.87 (95% CI 0.73 to 1.03) for bowel resection — confidence interval crosses 1.0
The authors described these findings as 'marginally significant lower risk'
793 bowel resections occurred over a median 14.6-year follow-up
Methods
The study included 4262 cancer-free IBD patients at baseline drawn from the UK Biobank cohort of 502,411 participants.
Participants were recruited between 2006 and 2010 in the UK Biobank
Median follow-up duration was 14.6 years
Patients were categorised as poor (score 0-2), intermediate (score 3), or healthy (score 4-5) sleep pattern
Sleep score assigned 1 point each for: sleep 7-8 hours/day, early chronotype, no snoring, never/rarely insomnia symptoms, and no frequent daytime sleepiness
What This Means
This research examined whether sleep habits affect long-term health outcomes in people with inflammatory bowel disease (IBD), which includes conditions like Crohn's disease and ulcerative colitis. Using data from over 4,000 IBD patients in the UK Biobank followed for nearly 15 years on average, researchers scored participants' sleep based on five factors: sleeping 7-8 hours per night, being a morning person (early chronotype), not snoring, rarely having insomnia, and not experiencing frequent daytime sleepiness. They then looked at whether these sleep patterns were linked to survival and the need for bowel surgery.
The study found that IBD patients with healthy or intermediate sleep patterns had roughly 23-25% lower risk of dying from any cause compared to those with poor sleep patterns. Specifically, sleeping 7-8 hours per night was linked to a 21% lower death risk, and being a morning person was linked to an 18% lower death risk. For bowel surgery, the overall sleep pattern did not reach statistical significance, but patients who rarely or never experienced insomnia had a 22% lower risk of needing bowel resection.
This research suggests that sleep quality and habits may play a meaningful role in the long-term health of people living with IBD — not just comfort and quality of life, but potentially influencing survival and the need for major surgery. The findings point to sleep duration and chronotype (whether someone is naturally a morning or evening person) as particularly important factors. Because this was an observational study, it cannot prove that better sleep directly causes better outcomes, but the consistency of findings across multiple sleep measures and a long follow-up period strengthens the case for paying attention to sleep as part of IBD management.
Zhang Q, Xu F, Liu S, Zhu S, Zhang S, Wu S, et al.. (2026). Long-term risk of bowel resection and mortality associated with sleep behaviours and sleep pattern in patients with inflammatory bowel disease: a large-scale prospective cohort study.. Family medicine and community health. https://doi.org/10.1136/fmch-2025-003787