Abstract
The continuous reaction times (CRT) method describes arousal functions. Reaction time instability in a patient with liver disease indicates covert hepatic encephalopathy (cHE). The effects of sleep deprivation are unknown although cirrhosis patients frequently suffer from sleep disorders. The aim of this study was to determine if sleep deprivation influences the CRT test. Eighteen cirrhosis patients and 27 healthy persons were tested when rested and after one night’s sleep deprivation. The patients filled out validated sleep quality questionnaires. Seven patients (38 %) had unstable reaction times (a CRTindex < 1.9) compatible with cHE. In these patients, the wakefulness improved or normalized their reaction speed and CRTindex (p = 0.01). There was no change in the other patients’ reaction speed or stability. Seven patients (38 %) reported poor sleep that was not related to their CRT tests before or after the sleep deprivation. In the healthy participants, the sleep deprivation slowed their reaction times by 11 % (p < 0.0001) and in 7 persons (25 %) destabilized them. The acute sleep deprivation normalized or improved the reaction time stability of the patients with a CRTindex below 1.9 and had no effect in the patients with a CRTindex above 1.9. There was no relation between reported sleep quality and reaction time results. Thus, in cirrhosis patients, sleep disturbances do not lead to ‘falsely’ slowed and unstable reaction times. In contrast, the acute sleep deprivation slowed and destabilized the reaction times of the healthy participants. This may have negative consequences for decision-making.
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References
Arnedt JT et al (2005) Neurobehavioral performance of residents after heavy night call vs after alcohol ingestion. JAMA 294:1025–33
Barapatre RJ et al (1990) Changes in bronchoalveolar lavage and lung function in rheumatoid arthritis. A controlled study. J Assoc Phys India 38:562–3
Cordoba J et al (1998) High prevalence of sleep disturbance in cirrhosis. Hepatology 27:339–45
Doran SM, Van Dongen HP, Dinges DF (2001) Sustained attention performance during sleep deprivation: evidence of state instability. Arch Ital Biol 139:253–67
Elsass P et al (1985) Discrimination between organic and hepatic encephalopathy by means of continuous reaction times. Liver 5:29–34
Ennio De Renzi PF (1965) The comparative efficiency of intelligence and vigilance tests in detecting hemispheric cerebral damage. Cortex 1:410–33
Hefti K et al (2013) Increased metabotropic glutamate receptor subtype 5 availability in human brain after one night without sleep. Biol Psychiatry 73:161–8
Kappus MR, Bajaj JS (2012) Covert hepatic encephalopathy: not as minimal as you might think. Clin Gastroenterol Hepatol 10:1208–19
Landrigan CP et al (2004) Effect of reducing interns’ work hours on serious medical errors in intensive care units. N Engl J Med 351:1838–48
Lauridsen MM, Jepsen P, Vilstrup H (2011) Critical flicker frequency and continuous reaction times for the diagnosis of minimal hepatic encephalopathy: a comparative study of 154 patients with liver disease. Metab Brain Dis 26:135–9
Lauridsen MM et al (2012) Gender and age effects on the continuous reaction times method in volunteers and patients with cirrhosis. Metab Brain Dis 27:559–565
Lauridsen MM et al (2013) The continuous reaction times method for diagnosing, grading, and monitoring minimal/covert hepatic encephalopathy. Metab Brain Dis 28(2):231–4
Lim J, Dinges DF (2008) Sleep deprivation and vigilant attention. Ann N Y Acad Sci 1129:305–22
Maldonado-Garza HJ et al (2011) Prevalence of minimal hepatic encephalopathy in cirrhotic patients. Ann Hepatol 10(Suppl 2):S40–4
Marchesini G et al (2001) Factors associated with poor health-related quality of life of patients with cirrhosis. Gastroenterology 120:170–8
Marcus CL, Loughlin GM (1996) Effect of sleep deprivation on driving safety in housestaff. Sleep 19:763–6
Mittal VV et al (2011) A randomized controlled trial comparing lactulose, probiotics, and L-ornithine L-aspartate in treatment of minimal hepatic encephalopathy. Eur J Gastroenterol Hepatol 23:725–32
Montagnese S et al (2009a) Sleep and circadian abnormalities in patients with cirrhosis: features of delayed sleep phase syndrome? Metab Brain Dis 24:427–39
Montagnese S et al (2009b) Sleep-wake patterns in patients with cirrhosis: all you need to know on a single sheet. A simple sleep questionnaire for clinical use. J Hepatol 51:690–5
Montagnese S et al (2009c) Night-time sleep disturbance does not correlate with neuropsychiatric impairment in patients with cirrhosis. Liver Int 29:1372–82
Murck H, Schubert MI, Schmid D, Schüssler P, Steiger A, Auer DP (2009) The glutamatergic system and its relation to the clinical effect of therapeutic-sleep deprivation in depression - an MR spectroscopy study. J Psychiatr Res 43:175–80
O’Brien MJ et al (2012) Does sleep deprivation impair orthopaedic surgeons’ cognitive and psychomotor performance? J Bone Joint Surg Am 94:1975–81
Renzi D (1965) The comparative efficiency of intelligence and vigilance tests in detecting hemispheric cerebral damage. Cortex 1:410–433
Taheri M, Arabameri E (2012) The effect of sleep deprivation on choice reaction time and anaerobic power of college student athletes. Asian J Sports Med 3:15–20
Ware JC et al (2006) Medical resident driving simulator performance following a night on call. Behav Sleep Med 4:1–12
Wichniak A, Wierzbicka A, Jernajczyk W (2013) Sleep as a biomarker for depression. Int Rev Psychiatry 25:632–45
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Lauridsen, M.M., Frøjk, J., de Muckadell, O.B.S. et al. Opposite effects of sleep deprivation on the continuous reaction times in patients with liver cirrhosis and normal persons. Metab Brain Dis 29, 655–660 (2014). https://doi.org/10.1007/s11011-014-9583-7
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DOI: https://doi.org/10.1007/s11011-014-9583-7