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Metabolic Brain Disease

, Volume 32, Issue 2, pp 595–605 | Cite as

Sleep disturbances in patients of liver cirrhosis with minimal hepatic encephalopathy before and after lactulose therapy

  • Jatinderpal Singh
  • Barjesh Chander SharmaEmail author
  • Vinod Puri
  • Sanjeev Sachdeva
  • Siddharth Srivastava
Original Article

Abstract

Sleep disturbances are common in patients of cirrhosis with minimal hepatic encephalopathy (MHE) and affect health related quality of life (HRQOL). No study has evaluated effect of lactulose on sleep disturbances and correlation with HRQOL in patients with MHE. We assessed sleep disturbances in cirrhosis with MHE and effect of lactulose on sleep disturbances and HRQOL. One hundred patients of cirrhosis [MHE; (n = 50, age 45.3 ± 11.2 years, 45 males) no-MHE (n = 50, age 46.3 ± 10.4 years, 44 males)] were included. MHE was diagnosed with psychometric hepatic encephalopathy score (PHES) ≤ −5. All patients underwent laboratory parameters including arterial ammonia and critical flicker frequency (CFF) Sleep disturbances were measured with Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and polysomnography. HRQOL was measured with SF-36(v2) questionnaire. Patients with MHE were given lactulose therapy for 3 months and all the parameters were repeated. Poor quality of sleep and excessive day time sleepiness were more common in patients with MHE, compared to without MHE. With lactulose therapy there was improvement in MHE in 21 patients and arterial ammonia levels (93.74 ± 14.8 vs. 71.44 ± 18.8 μmol/L: p < 0.001), CFF (34.83 ± 3.54 vs. 39.44 ± 4.95 Hz: p < 0.001), PHES (−7.64 ± 2.1 vs. -5.58 ± 2.09: p < 0.001), PSQI (8.6 ± 3.3 vs. 5.2 ± 1.5: p < 0.001), ESS (12.52 ± 3.01 vs. 9.24 ± 2.27: p < 0.001) and HRQOL (p = 0.01). Excessive day time sleepiness and impaired sleep quality are common in patients with MHE and correlate with neuropsychiatric impairment. Improvement in MHE with lactulose also leads to improvement in sleep disturbances and HRQOL.

Keywords

Hepatic encephalopathy Lactulose 

Abbreviations

MHE

Minimal hepatic encephalopathy

HE

Hepatic encephalopathy

PHES

Psychometric hepatic encephalopathy score

CTP

Child turcotte pugh

MELD

Model for end stage liver disease

CFF

Critical flicker frequency

PSG

Polysomnography

ESS

Epworth sleepiness scale

PSQI

Pittsburg sleep quality index

HRQOL

Health related quality of life

CI

Confidence interval

r

Correlation coefficient

Notes

Compliance with ethical standards

Conflict of interest

All authors have no conflicts (financial, professional, or personal) that are relevant to the manuscript.

Funding source

None.

Grant support

Nil

Supplementary material

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Table S1 (DOCX 14 kb)
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Table S6 (DOCX 14 kb)

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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Jatinderpal Singh
    • 1
  • Barjesh Chander Sharma
    • 1
    Email author
  • Vinod Puri
    • 2
  • Sanjeev Sachdeva
    • 1
  • Siddharth Srivastava
    • 1
  1. 1.Department of GastroenterologyG. B. Pant Institute of Postgraduate Medical Education and ResearchNew DelhiIndia
  2. 2.Department of NeurologyG. B. Pant Institute of Postgraduate Medical Education and ResearchNew DelhiIndia

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