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. 2017 Aug;15(8):1271-1278.e6.
doi: 10.1016/j.cgh.2017.01.027. Epub 2017 Feb 3.

Most Individuals With Advanced Cirrhosis Have Sleep Disturbances, Which Are Associated With Poor Quality of Life

Marwan Ghabril  1 , Mollie Jackson  2 , Raghavender Gotur  2 , Regina Weber  2 , Eric Orman  2 , Raj Vuppalanchi  2 , Naga Chalasani  2
Affiliations

Most Individuals With Advanced Cirrhosis Have Sleep Disturbances, Which Are Associated With Poor Quality of Life

Marwan Ghabril et al. Clin Gastroenterol Hepatol. 2017 Aug.

Abstract

Background & aims: Sleep disturbances are common in patients with cirrhosis, but their determinants and effects on health-related quality of life are not well-understood. We investigated the prevalence of disturbed sleep in these patients, factors associated with sleep disruption, and effects on quality of life.

Methods: We performed a prospective, cross-sectional study of 193 stable ambulatory patients with cirrhosis (154 with decompensated cirrhosis). Participants completed the Pittsburgh Sleep Quality Index (to assess sleep quality), the Chronic Liver Disease Questionnaire (CLDQ), and muscle cramp questionnaires and underwent neurocognitive testing. Actigraphy was performed in a subset of patients with normal and disturbed sleep. We collected serum samples from subjects with normal and disturbed sleep and performed non-targeted metabolomic analyses.

Results: Of the study subjects, 157 (81%) had disturbed sleep, with Pittsburgh Sleep Quality Index scores >5. Disturbed sleep was associated with muscle cramps, daytime somnolence, and decreased quality of life on the basis of CLDQ scores. Factors independently associated with disturbed sleep in logistic regression analysis included hypoalbuminemia, opiate therapy, and muscle cramps. Disturbed sleep was independently associated with CLDQ score (correlation parameter, -36.6; 95% confidence interval, -24 to -49; P < .001) on linear regression. Disturbed sleep was associated with neurocognitive impairment and with significantly delayed bedtime and decreased total sleep time, measured by actigraphy. Disturbed sleep was associated with metabolome signatures of alterations to the intestinal microbiome and lipid, arginine, and urea cycle metabolism.

Conclusions: Most patients with advanced cirrhosis (81%) have disturbed sleep. This has negative effects on quality of life and is associated with disruptions of several metabolic pathways, including metabolism by the intestinal microbiota.

Keywords: Actigraphy; CLDQ; Metabolome; PSQI.

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Conflict of interest statement

Author disclosures:

The following authors have no conflicts of interest related to this study; Marwan Ghabril, Mollie Jackson, Raghav Gotur, Edra Nordstrom, Regina Weber, Eric Orman, Raj Vuppalanchi, Naga Chalasani.

Figures

Figure 1
Figure 1
A box plot describing Chronic Liver Disease Quality of life questionnaire (CLDQ) scores (median (bold horizontal line), interquartile range (box), and range (whiskers)) in subjects grouped according to category of sleep disturbance, including; normal, mild, moderate and severe. Comparisons of CLDQ between all categories were statistically significant, with the exception of mild versus moderate sleep disturbance.
Figure 2
Figure 2
The Random Forest classification and biochemical importance plot listing the metabolites in order of degree of alteration between patients with no and any sleep disturbance (2A), and between patients with no, mild and severe sleep disturbance (2B).
Figure 2
Figure 2
The Random Forest classification and biochemical importance plot listing the metabolites in order of degree of alteration between patients with no and any sleep disturbance (2A), and between patients with no, mild and severe sleep disturbance (2B).
See this image and copyright information in PMC

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