The association of insomnia with gastroesophageal reflux symptoms in biopsy-proven nonalcoholic fatty liver disease
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It is suggested that nonalcoholic fatty liver disease (NAFLD), including nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH), can be associated with insomnia and gastro-esophageal reflux disease (GERD). The relationship between GERD and insomnia in subjects with biopsy-proven NAFLD was investigated.
This study enrolled 123 patients with biopsy-proven NAFLD. Insomnia was assessed by the Athens Insomnia Scale (AIS), a self-assessment psychometric instrument designed to quantify sleep difficulty based on ICD-10 criteria; AIS scores ≥ 6 were considered positive for insomnia. GERD symptoms were evaluated using a frequency scale for the symptoms of GERD (FSSG); FSSG scores ≥ 8 were considered positive. Logistic regression models were used to evaluate the association of insomnia with GERD, after adjusting for potential confounders. Thirteen patients with GERD were treated with the proton pump inhibitor rabeprazole (RPZ; 10 mg/day), for 12 weeks.
Of the 123 patients, 76 (62 %) were female and 87 (71 %) were obese, with 34 (28 %) having AIS scores ≥ 6 and 31 (25 %) having FSSG scores ≥ 8. Liver biopsy revealed that 40 patients (33 %) had NAFL and 83 (67 %) had NASH. FSSG and AIS scores were similar in the two groups. HOMA-IR, FSSG scores and γGT (GGT) concentrations were significantly higher in insomniacs than in non-insomniacs. Logistic regression analysis demonstrated that FSSG score and GGT concentration were independently associated with insomnia. RPZ treatment resulted in significantly reductions in both AIS and FSSG scores.
Nearly 30 % of patients with biopsy-proven NAFLD had insomnia, which was related to GGT and GERD and could be relieved by RPZ treatment.
KeywordsGERD Insomnia Nonalcoholic fatty liver disease Proton-pump inhibitor
Body mass index
Gastro-esophageal reflux disease
Nonalcoholic fatty liver disease
Conflict of interest
Yuichiro Eguchi received a research grant from Bristol-Myers Squibb. Yoshito Itoh received commercial research funds from Dainippon Sumitomo Pharma Co., Ltd.
- 7.Fujikawa Y, Tominaga K, Fujii H, Machida H, Okazaki H, Yamagami H, et al. High prevalence of gastroesophageal reflux symptoms in patients with non-alcoholic fatty liver disease associated with serum levels of triglyceride and cholesterol but not simple visceral obesity. Digestion. 2012;86:228–37.PubMedCrossRefGoogle Scholar
- 19.Committee on the Classification and Diagnostic Criteria of Diabetes Mellitus. Report of the Committee on the Classification and Diagnostic Criteria of Diabetes Mellitus. J Jpn diabetes Soc. 2010;53:450–67.Google Scholar
- 24.Furuta T, Shimatani T, Sugimoto M, Ishihara S, Fujiwara Y, Kusano M, et al. Investigation of pretreatment prediction of proton pump inhibitor (PPI)-resistant patients with gastroesophageal reflux disease and the dose escalation challenge of PPIs-TORNADO study: a multicenter prospective study by the Acid-Related Symptom Research Group in Japan. J Gastroenterol. 2011;46:1273–83.PubMedCrossRefGoogle Scholar
- 33.Yoshioka E, Saijo Y, Kita T, Satoh H, Kawaharada M, Kishi R. Effect of the interaction between employment level and psychosocial work environment on insomnia in male Japanese public service workers. Int J Behav Med. 2012. doi: 10.1007/s12529-012-9230-9.