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Cirrhosis patients report lower QOL due to sleep disturbances

Most patients with advanced cirrhosis have disturbed sleep, which leads to a decrease in quality of life, according to study results published in Clinical Gastroenterology and Hepatology.

The study included 193 adult patients with cirrhosis who visited the hepatology outpatient clinics at Indiana University between December 2012 and January 2014. Thirty-six patients had subjectively good sleep and researchers considered 157 to have poor sleep as determined by mild, moderate or severe disturbances.

Seventy-one percent of patients with Child-Pugh class A reported poor sleep, as did 85% with class B and 93% with class C (P = .02). Further, 70% of patients with compensated cirrhosis and 84% with decompensated cirrhosis (P = .04) reported poor sleep.

The researchers found an association between lowered quality of life in the patients who had poor sleep (correlation parameter –36.6, 95% CI, –24 to –49), muscle cramps (correlation parameter –18.8, 95% CI, –9.5 to –28.1) and hepatic encephalopathy (correlation parameter –16.7, 95% CI, –7.7 to –25.7).

Eleven participants with good sleep and 10 participants with poor sleep completed actigraphy over a median of 14 days. Researchers associated poor sleep with a delayed bed time (P = .02) and shorter total sleep time (P = .04).

While the researchers were not able to establish a cause and effect association between their metabolic analysis and the patients with cirrhosis and poor sleep, the patients with poor sleep did have a distinct serum metabolic signature reflecting derangement of several metabolic pathways, including gut microbial metabolism. Of the 80 patients who underwent the metabolic analysis, there were 45 metabolites that differed significantly between the patients with no and mild sleep disturbance, 54 differed between those with no and severe disturbance and 45 differed between those with mild and severe disturbance. 

“Disturbed sleep in this population appears to be multi-factorial in etiology, and may be associated with neurocognitive dysfunction,” the researchers concluded. “Further studies to elucidate the pathogenesis and therapies for disturbed sleep in patients with cirrhosis are needed in the face of this significant and unmet need.” – by Talitha Bennett

Disclosures: The researchers report no relevant financial disclosures.