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Metabolic Brain Disease
Published in: Metabolic Brain Disease 2/2013

01-06-2013 | Original Paper

Correlation between degree and quality of sleep disturbance and the level of neuropsychiatric impairment in patients with liver cirrhosis

Authors: Jayanta Samanta, Radha K. Dhiman, Amit Khatri, Kiran K. Thumburu, Sandeep Grover, Ajay Duseja, Yogesh Chawla

Published in: Metabolic Brain Disease | Issue 2/2013

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Abstract

Sleep disturbances are common in patients of cirrhosis and has a significant effect on their health related quality of life (HRQOL). Thus far, no study has demonstrated a systematically studied significant correlation between the sleep disturbance observed and the neuropsychiatric impairment status of patients of cirrhosis. On the basis of PHES, we divided 100 cirrhotics into those having minimal hepatic encephalopathy (MHE) (PHES≤−5) and those not (NMHE). Now, in these MHE (n=46) and NMHE (n=54) patients, sleep disturbance was measured with Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) and HRQOL with SF-36(v2) questionnaire. Sixty (60 %) patients were found to be ‘poor sleepers’ (PSQI>5) while 38 (38 %) patients had excessive daytime sleepiness (ESS≥11). Univariate and multivariate analyses showed MHE has significant effect among ‘poor sleepers’ (P<0.0001) as well as on those with EDS (P<0.0001). Significant correlation existed between PHES and both the sleep parameters of PSQI (r = −0.518, P <0.0001) as well as ESS (r = −0.383, P <0.0001), implying independently strong correlation between poor cognition and the presence of night time sleep disturbance and excessive daytime sleepiness among cirrhotics. Significant correlation existed between PSQI and ESS and the various scales and component scores of SF-36(v2) signifying the negative impact of sleep disturbance on the HRQOL. In conclusion, both night time sleep disturbance and excessive daytime sleepiness have significant relation with the neuropsychiatric impairment in patients of cirrhosis and are significantly associated with the observed impairment in HRQOL.
Literature
Affleck G, Urrows S, Tennen H, Higgins P, Abeles M (1996) Sequential daily relations of sleep, pain intensity, and attention to pain among women with fibromyalgia. Pain 68:363–368PubMedCrossRef
Bajaj JS, Saeian K, Schubert CM, Franco R, Franco J, Heuman DM (2011a) Disruption of sleep architecture in minimal hepatic encephalopathy and ghrelin secretion. Aliment Pharmacol Ther 34:103–105
Bajaj JS, Heuman DM, Wade JB, Gibson DP, Saeian K, Wegelin JA, Hafeezullah M, Bell DE, Sterling RK, Stravitz RT, Fuchs M, Luketic V, Sanyal AJ (2011b) Rifaximin improves driving simulator performance in a randomized trial of patients with minimal hepatic encephalopathy. Gastroenterology 140:478–487PubMedCrossRef
Bersagliere A, Raduazzo ID, Nardi M, Schiff S, Gatta A, Amodio P, Achermann P, Montagnese S (2012) Induced hyperammonemia may compromise the ability to generate restful sleep in patients with cirrhosis. Hepatology 55:869–878PubMedCrossRef
Bianchi G, Marchesini G, Nicolino F, Graziani R, Sgarbi D, Loguercio C, Abbiati R, Zoli M (2005) Psychological status and depression in patients with liver cirrhosis. Dig Liver Dis Off J Ital Soc Gastroenterol Ital Assoc Study Liver 37:593–600CrossRef
Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213PubMedCrossRef
Cauli O, Rodrigo R, Piedrafita B, Boix J, Felipo V (2007) Inflammation and hepatic encephalopathy: ibuprofen restores learning ability in rats with porto-caval shunts. Hepatology 46:514–519PubMedCrossRef
Cordoba J, Cabrera J, Lataif L, Penev P, Zee P, Blei AT (1998) High prevalence of sleep disturbance in cirrhosis. Hepatology 27:339–345PubMedCrossRef
De Cruz S, Espiritu JR, Zeidler M, Wang TS (2012) Sleep disorders in chronic liver disease. Semin Respir Crit Care Med 33:26–35PubMedCrossRef
De Rui M, Schiff S, Aprile D, Angeli P, Bombonato G, Bolognesi M, Sacerdoti D, Gatta A, Merkel C, Amodio P, Montagnese S (2012) Excessive daytime sleepiness and hepatic encephalopathy: it is worth asking. Metab Brain Dis. doi:10.​1007/​s11011-012-9360-4
Dhiman RK, Saraswat VA, Sharma BK, Sarin SK, Chawla YK, Butterworth R, Duseja A, Aggarwal R, Amarapurkar D, Sharma P, Madan K, Shah S, Seth AK, Gupta RK, Koshy A, Rai RR, Dilawari JB, Mishra SP, Acharya SK, Indian National Association for Study of the Liver (2010a) Minimal hepatic encephalopathy: consensus statement of a working party of the Indian National Association for Study of the Liver. J Gastroenterol Hepatol 25:1029–1041CrossRef
Dhiman RK, Kurmi R, Thumburu KK, Venkataramarao SH, Agarwal R, Duseja A, Chawla Y (2010b) Diagnosis and prognostic significance of minimal hepatic encephalopathy in patients with cirrhosis of liver. Dig Dis Sci 55:2381–2390CrossRef
Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT (2002) Hepatic encephalopathy—definition, nomenclature, diagnosis, and quan-tification: final report of theworking party at the 11thWorldCongresses of Gastroenterology, Vienna, 1998. Hepatology 35:716–721PubMedCrossRef
Groeneweg M, Quero JC, De Bruijn I, Hartmann IJ, Essink-bot ML, Hop WC, Schalm SW (1998) Subclinical hepatic encephalopathy impairs daily functioning. Hepatology 28:45–49PubMedCrossRef
Gulbay BE, Acican T, Onen ZP, Yildiz OA, Baccioglu A, Arslan F, Köse K (2008) Health-related quality of life in patients with sleep-related breathing disorders: relationship with nocturnal parameters, daytime symptoms and comorbid diseases. Respiration 75:393–401PubMedCrossRef
Ichikawa T, Naota T, Miyaaki H, Miuma S, Isomoto H, Takeshima F, Nakao K (2010) Effect of an oral branched chain amino acid-enriched snack in cirrhotic patients with sleep isturbance. Hepatol Res 40:971–978PubMedCrossRef
Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545PubMed
Kanwal F, Gralnek IM, Hays RD, Zeringue A, Durazo F, Han SB, Saab S, Bolus R, Spiegel BM (2009) Health-related quality of life predicts mortality in patients with advanced chronic liver dis-ease. Clin Gastroenterol Hepatol 7:793–799PubMedCrossRef
Kristensson K, Nygård M, Bertini G, Bentivoglio M (2010) African trypanosome infections of the nervous system: parasite entry and effects on sleep and synaptic functions. Prog Neurobiol 91:152–171PubMedCrossRef
Leger D, Scheuermaier K, Philip P, Paillard M, Guilleminault C (2001) SF-36: evaluation of quality of life in severe and mild insomniacs compared with good sleepers. Psychosom Med 63:49–55PubMed
Marchesini G, Bianchi G, Amodio P, Salerno F, Merli M, Panella C, Loguercio C, Apolone G, Niero M, Abbiati R, Italian Study Group for quality of life in cirrhosis (2001) Factors associated with poor health-related quality of life of patients with cirrhosis. Gastroenterology 120:170–178PubMedCrossRef
Means MK, Lichstein KL, Epperson MT, Johnson CT (2000) Relaxation therapy for insomnia: nighttime and day time effects. Behav Res Ther 38:665–678PubMedCrossRef
Montagnese S, Middleton B, Skene DJ, Morgan MY (2009) Night-time sleep disturbance does not correlate with neuropsychiatric impairment in patients with cirrhosis. Liver Int Off J Int Assoc Study Liver 29:1372–1382CrossRef
Montagnese S, Middleton B, Mani AR, Skene DJ, Morgan MY (2010) On the origin and the consequences of circadian abnormalities in patients with cirrhosis. Am J Gastroenterol 105:1773–1781PubMedCrossRef
Mostacci B, Ferlisi M, Baldi Antognini A, Sama C, Morelli C, Mondini S, Cirignotta F (2008) Sleep disturbance and daytime sleepiness in patients with cirrhosis: a case control study. Neurol Sci 29:237–240PubMedCrossRef
Newcombe RG (1998) Two-sided confidence intervals for the single proportion: comparison of seven methods. Stat Med 17:857–872PubMedCrossRef
Prasad S, Dhiman RK, Duseja A, Chawla YK, Sharma A, Agarwal R (2007) Lactulose improves cognitive functions and health-related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy. Hepatology 45:549–559PubMedCrossRef
Rodrigo R, Cauli O, Gomez-Pinedo U, Agusti A, Hernandez-Rabaza V, Garcia-Verdugo JM, Felipo V (2010) Hyperammonemia induces neuroinflammation that contributes to cognitive impairment in rats with hepatic encephalopathy. Gastroenterology 139:675–684PubMedCrossRef
Sidhu SS, Goyal O, Mishra BP, Sood A, Chhina RS, Soni RK (2011) Rifaximin improves psychometric performance and health-related quality of life in patients with minimal hepatic encephalopathy (the RIME Trial). Am J Gastroenterol 106:307–316PubMedCrossRef
Steindl PE, Finn B, Bendok B, Rothke S, Zee PC, Blei AT (1995) Disruption of the diurnal rhythm of plasma melatonin in cirrhosis. Ann Intern Med 123:274–277PubMedCrossRef
Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483PubMedCrossRef
Zammit GK, Weiner J, Damato N, Sillup GP, McMillan CA (1999) Quality of life in people with insomnia. Sleep 22(Suppl 2):S379–S385PubMed
Zee PC, Mehta R, Turek FW, Blei AT (1991) Portacaval anastomosis disrupts circadian locomotor activity and pineal melatonin rhythms in rats. Brain Res 560(1–2):17–22PubMedCrossRef
Metadata
Title
Correlation between degree and quality of sleep disturbance and the level of neuropsychiatric impairment in patients with liver cirrhosis
Authors
Jayanta Samanta
Radha K. Dhiman
Amit Khatri
Kiran K. Thumburu
Sandeep Grover
Ajay Duseja
Yogesh Chawla
Publication date
01-06-2013
Publisher
Springer US
Published in
Metabolic Brain Disease / Issue 2/2013
Print ISSN: 0885-7490
Electronic ISSN: 1573-7365
DOI
https://doi.org/10.1007/s11011-013-9393-3

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