• cirrhosis;
  • diurnal preference;
  • health-related quality of life;
  • hepatic encephalopathy;
  • sleep disturbance;
  • somnolence


Background: Sleep–wake disturbances are common in patients with cirrhosis and are generally attributed to the presence of hepatic encephalopathy.

Aim: To determine the relationship between sleep and neuropsychiatric disturbances in patients with cirrhosis.

Methods: The study population comprised 87 patients, classified as neuropsychiatrically unimpaired or as having minimal/overt hepatic encephalopathy. Nineteen healthy volunteers served as controls. Validated questionnaires were used to assess sleep quality [Pittsburgh sleep quality index (PSQI)], day-time sleepiness [Epworth sleepiness scale (ESS)] and diurnal preference. Health-related quality of life (H-RQoL) was assessed using the 36-item short form health profile (SF-36v1) and the chronic liver disease questionnaire.

Results: Patients slept significantly less well than the healthy volunteers (PSQI score: 8.4 ± 4.9 vs. 4.6 ± 2.5, P<0.01) and had more pronounced day-time sleepiness (abnormal ESS: 21 vs. 0%; χ2=3.8, P=0.05). No significant relationships were observed between sleep indices and the presence/degree of hepatic encephalopathy. H-RQoL was significantly impaired in the patients (SF-36v1 physical score: 36 ± 15 vs. 50 ± 10, P<0.001; SF-36v1 mental score: 46 ± 11 vs. 50 ± 10, P<0.01); night-time sleep disturbance was an independent predictor of poor H-RQoL (P<0.01).

Conclusions: Sleep–wake abnormalities are common in patients with cirrhosis; they significantly affect H-RQoL but are not related to the presence of hepatic encephalopathy.