Night-time sleep disturbance does not correlate with neuropsychiatric impairment in patients with cirrhosis
Article first published online: 14 AUG 2009
© 2009 John Wiley & Sons A/S
Volume 29, Issue 9, pages 1372–1382, October 2009
How to Cite
Montagnese, S., Middleton, B., Skene, D. J. and Morgan, M. Y. (2009), Night-time sleep disturbance does not correlate with neuropsychiatric impairment in patients with cirrhosis. Liver International, 29: 1372–1382. doi: 10.1111/j.1478-3231.2009.02089.x
- Issue published online: 3 SEP 2009
- Article first published online: 14 AUG 2009
- Received 18 February 2009 Accepted 26 June 2009
- diurnal preference;
- health-related quality of life;
- hepatic encephalopathy;
- sleep disturbance;
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.