Metabolic Brain Disease

, Volume 28, Issue 2, pp 249–259

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

Abstract

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.

Keywords

Hepatic encephalopathy Sleep disturbance Quality of life Cognition Somnolence 

Abbreviations

ALT

alanine aminotransferase

BP

bodily pain

CTP

Child-Turcotte-Pugh

ESS

Epworth Sleepiness Scale

EDS

excessive daytime sleepiness

GH

general health

HRQOL

health related quality of life

HE

hepatic encephalopathy

MCS

mental component summary

MH

mental health

MHE

minimal hepatic encephalopathy

MMSE

mini-mental state examination

MELD

model for end-stage liver disease

NMHE

no-MHE

PCS

physical component summary

PF

physical functioning

PSQI

Pittsburgh Sleep Quality Index

PHES

psychometric hepatic encephalopathy score

RE

role-limitation emotional

RP

role-limitation physical

SF

social functioning

VT

vitality

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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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