Metabolic Brain Disease

, Volume 28, Issue 2, pp 249–259 | Cite as

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

  • Jayanta Samanta
  • Radha K. Dhiman
  • Amit Khatri
  • Kiran K. Thumburu
  • Sandeep Grover
  • Ajay Duseja
  • Yogesh Chawla
Original Paper


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.


Hepatic encephalopathy Sleep disturbance Quality of life Cognition Somnolence 



alanine aminotransferase


bodily pain




Epworth Sleepiness Scale


excessive daytime sleepiness


general health


health related quality of life


hepatic encephalopathy


mental component summary


mental health


minimal hepatic encephalopathy


mini-mental state examination


model for end-stage liver disease




physical component summary


physical functioning


Pittsburgh Sleep Quality Index


psychometric hepatic encephalopathy score


role-limitation emotional


role-limitation physical


social functioning





JS received Young Investigator Award from International Society for Hepatic Encephalopathy and Nitrogen Metabolism (ISHEN) for presenting this research work at 15th ISHEN Symposium held in Grenaa, Denmark from May 29 to June 2, 2012. JS also received complimentary access to SF-36v2 for this research work from QualityMetric, Rhode Island, USA.

Conflicts of interest



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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Jayanta Samanta
    • 1
  • Radha K. Dhiman
    • 1
  • Amit Khatri
    • 1
  • Kiran K. Thumburu
    • 1
  • Sandeep Grover
    • 2
  • Ajay Duseja
    • 1
  • Yogesh Chawla
    • 1
  1. 1.Department of HepatologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
  2. 2.Department of PsychiatryPostgraduate Institute of Medical Education and ResearchChandigarhIndia

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