Night-time sleep disturbance does not correlate with neuropsychiatric impairment in patients with cirrhosis

Liver Int. 2009 Oct;29(9):1372-82. doi: 10.1111/j.1478-3231.2009.02089.x. Epub 2009 Aug 14.


Background: Sleep-wake disturbances are common in patients with cirrhosis and are generally attributed to the presence of hepatic encephalopathy.

Aim: To determine the relationship between sleep and neuropsychiatric disturbances in patients with cirrhosis.

Methods: The 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.

Results: Patients 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).

Conclusions: Sleep-wake abnormalities are common in patients with cirrhosis; they significantly affect H-RQoL but are not related to the presence of hepatic encephalopathy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Hepatic Encephalopathy / complications*
  • Hepatic Encephalopathy / psychology
  • Humans
  • Liver / physiopathology
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / psychology
  • Male
  • Middle Aged
  • Quality of Life
  • Sleep Wake Disorders / etiology*
  • Sleep Wake Disorders / psychology