The Impact of Different Bowel Preparation Approaches on Nocturnal Awakenings, Sleep Loss, and Travel Interruption
Douglas K. Rex, MD, MASGE, reviewing Tse C, et al. Am J Gastroenterol 2022 Sep 21.
This is a subinvestigation of a randomized bowel preparation trial in 10 Canadian centers. Patients were divided into 2 groups and underwent colonoscopy either in the early morning (7:30 am-10:30 am) or afternoon (10:30 am-4:30 pm). Patients scheduled for early morning colonoscopies were randomized to receive (1) a single 4L dose of polyethylene glycol (PEG) the evening before colonoscopy, (2) a high-volume split-dose regimen of 4L PEG, or (3) a 2L split dose of PEG plus 15 mg of bisacodyl at 2:00 pm the day before. Patients scheduled for afternoon colonoscopies were randomized to (1) a 2L single-dose of PEG the morning of colonoscopy plus 15 mg of bisacodyl at 2:00 pm the day before, (2) a 2L split dose of PEG plus 15 mg of bisacodyl at 2:00 pm the day before, or (3) a 4L split dose of PEG.
A 4L dose of PEG the evening before colonoscopy produced the worst preparation quality and the most time awakening for bowel movements. A split-dose high-volume preparation produced the greatest loss in sleep hours, but all the preparations were associated with significant loss of sleep, including same-day low-volume preparation.
There were no differences among the preparations in travel interruption due to a bowel movement. The only predictor of travel interruption was a duration of travel >1 hour.
In terms of efficacy, the preparations were comparable except for quality with the high-dose preparation the evening before colonoscopy.
COMMENTThese data support the abandonment of evening-before preparations. Consuming bowel preparation the evening before colonoscopy resulted in both the worst-quality preparation and the most nocturnal awakenings for bowel movements. The data also support the increasing movement toward low-volume preparations, which were as effective as high-volume preparations, at least in patients without clinical predictors of inadequate preparation. Finally, travel disruption should not be considered in the selection of bowel preparation regimens, as it occurs in all preparations to a comparable degree.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Tse C, Barkun A, Martel M, et al. Sleep disturbances, bowel movement kinetics and travel interruption with bowel preparation – A Bowel CLEANsing National Initiative Sub-study. Am J Gastroenterol 2022 Sep 21. (Epub ahead of print) (https://doi.org/10.14309/ajg.0000000000002026)
