• Sara Montagnese, Benita Middleton, Debra J Skene, and Marsha Y Morgan.
• Department of Clinical and Experimental Medicine, University of Padova, Italy.
• Liver Int. 2009 Oct 1; 29 (9): 1372-82.

BackgroundSleep-wake disturbances are common in patients with cirrhosis and are generally attributed to the presence of hepatic encephalopathy.AimTo determine the relationship between sleep and neuropsychiatric disturbances in patients with cirrhosis.MethodsThe study population comprised 87 patients, classified as neuropsychiatrically unimpaired or as having minimal/overt hepatic encephalopathy. Nineteen healthy volunteers served as controls. Validated questionnaires were used to assess sleep quality [Pittsburgh sleep quality index (PSQI)], day-time sleepiness [Epworth sleepiness scale (ESS)] and diurnal preference. Health-related quality of life (H-RQoL) was assessed using the 36-item short form health profile (SF-36v1) and the chronic liver disease questionnaire.ResultsPatients slept significantly less well than the healthy volunteers (PSQI score: 8.4 +/- 4.9 vs. 4.6 +/- 2.5, P<0.01) and had more pronounced day-time sleepiness (abnormal ESS: 21 vs. 0%; chi(2)=3.8, P=0.05). No significant relationships were observed between sleep indices and the presence/degree of hepatic encephalopathy. H-RQoL was significantly impaired in the patients (SF-36v1 physical score: 36 +/- 15 vs. 50 +/- 10, P<0.001; SF-36v1 mental score: 46 +/- 11 vs. 50 +/- 10, P<0.01); night-time sleep disturbance was an independent predictor of poor H-RQoL (P<0.01).ConclusionsSleep-wake abnormalities are common in patients with cirrhosis; they significantly affect H-RQoL but are not related to the presence of hepatic encephalopathy.

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