Relationship Between Sleep-Wake Disturbance and Risk of Malnutrition in Hospitalized Patients With Cirrhosis

Abstract

Both sleep-wake disturbance and malnutrition are common in cirrhosis and might be associated with similar adverse outcomes, such as impaired health-related quality of life, hepatic encephalopathy, and sarcopenia, but there is no study investigating the relationship between these two. We aimed to explore the relationship between sleep-wake disturbance [estimated by the Pittsburgh Sleep Quality Index (PSQI)] and malnutrition risk [estimated by the Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT)]. About 150 patients with cirrhosis were prospectively recruited. The nutritional risk is classified as low (0 points), moderate (1 point), and high (2-7 points) according to the RFH-NPT score. A global PSQI >5 indicated poor sleepers. Furthermore, multivariate linear regression analyses were performed to determine the relationship between sleep-wake disturbance and malnutrition. The median PSQI was seven, and RFH-NPT was two in the entire cohort, with 60.67 and 56.67% rated as poor sleep quality and high malnutrition risk, respectively. Patients with cirrhosis with poor sleep quality had significantly higher RFH-NPT score (3 vs. 1, P = 0.007). Our multivariate analyses indicated that male patients (β = 0.279, P < 0.001), ascites (β = 0.210, P = 0.016), and PSQI (β = 0.262, P = 0.001) were independent predictors of malnutrition. In addition, the differences regarding PSQI score were more significant in male patients, as well as those >65 years or with Child-Turcotte-Pugh class A/B (CTP-A/B) or the median model for end-stage liver disease (MELD) <15. Taken together, the sleep-wake disturbance is strongly correlated with high malnutrition risk in patients with cirrhosis. Given sleep-wake disturbance is remediable, it is tempting to incorporate therapies to reverse poor sleep quality for improving nutritional status in patients with cirrhosis.

Keywords: PSQI; RFH-NPT; liver cirrhosis; malnutrition; sleep-wake disturbance.

Figure 1

PSQI score stratified by nutritional status in all cases (A), male patients (B), female patients (C), patients aged <65 years (D), and aged 65 years and over (E). The risk of malnutrition was categorized into low (0 points), moderate (1 point), and high (2–7 points) in terms of RFH-NPT scores. PSQI, Pittsburgh Sleep Quality Index; RFH-NPT, Royal Free Hospital-Nutritional Prioritizing Tool.

Figure 2

PSQI score stratified by nutritional status in patients with CTP-A (A), CTP-B (B), CTP-C (C), MELD <15 (D), and MELD ≥ 15 points (E). The risk of malnutrition was categorized into low (0 points), moderate (1 point), and high (2–7 points) in terms of RFH-NPT scores. PSQI, Pittsburgh Sleep Quality Index; RFH-NPT, Royal Free Hospital-Nutritional Prioritizing Tool; CTP, Child-Turcotte-Pugh; MELD, model for end-stage liver disease.