All patients were asked to fill out questionnaires to assess sleep quality, GI symptoms, mental illness, and quality of life (QOL).

Sleep disturbance was evaluated by the Pittsburgh Sleep Quality Index (PSQI) [12], which consists of 17 individual items grouped into the following seven components: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficacy, sleep difficulty, hypnotic use, and daytime dysfunction. Each category receives a score of 0–3 (max total score 21). A higher total score indicates poorer sleep quality. The Japanese version of the PSQI has been validated and was used in the present study [11]. A total PSQI score of more than 5.5 was considered to indicate the presence of sleep disturbance [11].

The Epworth Sleepiness Scale (ESS) is a self-report instrument for measuring a patient’s daytime sleepiness [13]. It consists of eight questions, with a 4-point scale (scored 0–3) being used for each question. The total score is the sum of points from each question (i.e., 0–24) with a higher score indicating stronger subjective daytime sleepiness. The Japanese version of the ESS (JESS) has been validated and was used in the present study [14].

The Athens Insomnia Scale (AIS) was created to assess the severity of insomnia on the basis of the ICD-10 diagnostic criteria for insomnia [15]. The AIS consists of eight items rated on a 4-point scale (0 = on problem at all, 1 = slightly problematic, 2 = markedly problematic, 3 = extremely problematic). The cutoff score used to identify pathological insomnia was previously determined as a score of 6 points [16]. The Japanese version of the AIS has been validated and was used in the present study [17].

The Frequency Scale for the Symptoms of GERD (FSSG) is a questionnaire used to diagnose GERD and assess the response to treatment [18]. The modified FSSG (mFSSG) can assess both reflux-related and dyspepsia-related symptoms [19]. The mFSSG consists of 14 items, divided into seven items relating to reflux symptoms and seven relating to dyspepsia symptoms. A higher total score indicates more severe GERD or dyspepsia-related symptoms. We utilized the mFSSG in the present study.

The Gastrointestinal Symptom Rating Scale (GSRS) is used to evaluate general GI symptoms and consists of 15 items rated on a 7-point Likert scale [20]. The 15 items cover five subscales (reflux, abdominal pain, indigestion, diarrhea, and constipation).

The Constipation Scoring System (CSS) is used to evaluate the prevalence and severity of constipation [21]. The scoring system contains eight variables: frequency of bowel movement, difficult or painful evacuation, completeness of evacuation, abdominal pain, time per attempt, use and type of assistance (including laxatives, digitations, or enemas), number of unsuccessful attempts at evacuation in a 24-h period, and duration of constipation. The CSS consists of seven items scored on a 5-point Likert scale from 0 (none of the time) to 4 (all of the time), and one item (use and type of assistance) rated on a 0–2 scale. The total score can range from 0 (normal) to 30 (severe constipation), and a cutoff score of 15 suggests constipation.

Patient Assessment of Constipation Quality of Life (PAC-QOL) is used to measure the QOL in patients with constipation [22]. The PAC-QOL consists of 28 items grouped into four subscales (physical discomfort, psychosocial discomfort, worries and concerns, and satisfaction). The first three subscales provide a patient dissatisfaction index, with an overall score from 0 to 96 (lower scores correspond to better QOL). The satisfaction subscale includes four items with a global score from 0 to 16. Each patient’s self-reported definitive outcome is defined as poor (0–4), fairly good (5–8), good (9–12), or excellent (13–16). The Japanese version of the PAC-QOL (JPAC-QOL) has been validated and was used in the present study [23].

The Hospital Anxiety and Depression Scale (HADS) is used to evaluate anxiety and depression [24]. HADS is divided into an anxiety subscale (HADS-A) and a depression subscale (HADS-D). Each subscale contains seven items that are scored from 0 to 3, which give a total subscale score from 0 to 21. A higher HADS score indicates that the person is more depressive or more anxious. The Japanese version of the HADS has been validated and was used in the present study [25].

The Medical Outcome Trust 36-Item Short-Form Health Survey (SF-36) is used to evaluate health-related QOL in general. Items contribute toward assessment of eight components: physical functioning (PF), role physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role emotional (RE), and mental health (MH). The Japanese version of the SF-36 has been validated and was used in the present study [26].

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