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Night-time sleep disturbance does not correlate with neuropsychiatric impairment in patients with cirrhosis

Authors

  • Sara Montagnese,

    1. Current address: Department of Clinical and Experimental Medicine, University of Padova, Italy. Department of Medicine, The Centre for Hepatology, Royal Free Campus, University College London Medical School, University College London, London, UK
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  • Benita Middleton,

    1. Centre for Chronobiology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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  • Debra J. Skene,

    1. Centre for Chronobiology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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  • Marsha Y. Morgan

    1. Current address: Department of Clinical and Experimental Medicine, University of Padova, Italy. Department of Medicine, The Centre for Hepatology, Royal Free Campus, University College London Medical School, University College London, London, UK
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Correspondence
Dr Marsha Y. Morgan, Department of Medicine, The Centre for Hepatology, Royal Free Campus, University College London Medical School, University College London, Rowland Hill Street, London NW3 2PF, UK
Tel: +44 207 433 2873
Fax: +44 207 433 2871
e-mail: mymorgan@medsch.ucl.ac.uk

Abstract

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.

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