Sleep pattern changes in patients with liver cirrhosis

Abstract

Background: Liver cirrhosis is considered as a major cause of mortality worldwide and is the most common non-neoplastic cause of death among hepatobiliary and digestive diseases. One of the least studied complications of liver cirrhosis is the disturbed sleep pattern, which is being increasingly recognized as a major health problem affecting the quality of life. Methods: This study included two groups; the first group consisted of 30 patients diagnosed as liver cirrhosis based on abdominal ultrasound and liver biopsy and the second group consisted of 10 healthy subjects served as controls. ESS was calculated for every patient and all patients were subjected to complete overnight polysomnography to detect sleep disturbances among all participants. Results: Our results showed that cirrhotic patients had ESS, AHI and OSA significantly higher than the control group [16.4 ± 2.6 vs 11.1 ± 1.8, P = 0.0001; 10.9 ± 8.5 vs 2.4 ± 1.6, P = 0.005 and 3.1 ± 3.1 vs 1.1 ± 0.9, P = 0.03, respectively]. The percentage of sleep efficiency was significantly lower in cirrhotic patients than the control group [61.9 ± 12.9 vs 73.1 ± 7.6 (P = 0.02)]. Also, the percentages of S1, S3–S4 and REM sleep in relation to the total sleep time were significantly higher in the cirrhotic patients than the control group (P = 0.01, 0.02 and 0.06, respectively) while the percentage of S2 was significantly lower (P = 0.02). Cirrhotic patients of Child class C had ESS, AHI and OSA significantly higher and sleep efficiency significantly lower than cirrhotic patients of classes A and B (P = 0.001 for all). Cirrhotic patients with tense ascites had ESS, AHI and OSA significantly higher and sleep efficiency lower than patients with mild, moderate, or no ascites. Conclusion: This study revealed that cirrhotic patients had disturbed sleep pattern, correlating with the degree of cirrhosis.

Keywords

• Liver cirrhosis
• Polysomnography
• Sleep pattern
• Ascites