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Diaconu, C. Sleep among Patients with Chronic Liver Disease. Encyclopedia. Available online: https://encyclopedia.pub/entry/17882 (accessed on 17 November 2024).
Diaconu C. Sleep among Patients with Chronic Liver Disease. Encyclopedia. Available at: https://encyclopedia.pub/entry/17882. Accessed November 17, 2024.
Diaconu, Camelia. "Sleep among Patients with Chronic Liver Disease" Encyclopedia, https://encyclopedia.pub/entry/17882 (accessed November 17, 2024).
Diaconu, C. (2022, January 07). Sleep among Patients with Chronic Liver Disease. In Encyclopedia. https://encyclopedia.pub/entry/17882
Diaconu, Camelia. "Sleep among Patients with Chronic Liver Disease." Encyclopedia. Web. 07 January, 2022.
Sleep among Patients with Chronic Liver Disease
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This entry is adapted from the peer-reviewed paper 10.3390/jpm11121387

Sleep disturbances are commonly encountered among patients with CLDs and are associated with impaired HRQOL. The present study demonstrated that the more severe the liver disease, the poorer that sleep and QOL are. 

sleep chronic liver disease quality of life

1. Introduction

Quality of life (QOL) represents an important endpoint in healthcare and has been extensively studied in the past decades, especially among patients with chronic diseases [1][2]. Health-related QOL (HRQOL) is a complex concept that was described in various ways, “generally considered to reflect the impact of disease and treatment on disability and daily functioning“ (Mayo’s dictionary, 2016) [3].
Sleep health is less frequently defined in the literature compared to HRQOL, and it is mostly expressed in association with its outcomes. There are five main indicators of sleep health, measured either by self-reported and/or objective methods [4][5]:
  • Quality (subjectively assessed and divided into “good” or “poor” sleep);
  • Duration (time slept over 24 h);
  • Efficacy (sleep latency, wake after sleep onset);
  • Timing (chronotype—morning vs. evening type);
  • Alertness vs. sleepiness.
Based on these indicators, Buysse [5] defined sleep health as “a multidimensional pattern of sleep-wake-fulness, characterized by subjective satisfaction, appropriate timing, adequate duration, high efficiency, and sustained alertness during waking hours“ (Buysse DJ, 2014).
Worldwide, in 2017, chronic liver diseases (CLDs) were estimated to affect 1.5 billion persons, whose diagnoses included non-alcoholic fatty liver disease, viral hepatitis B and C, and alcoholic liver disease [6]. Apart from addressing the morbidity derived from major complications (e.g., liver cirrhosis and cancer), a deep focus has lately been oriented toward sleep disturbances/disorders (SDs) in patients with chronic liver disease (CLD) [7][8][9][10]. It was observed that sleep indicators are impaired in more than half of these patients and that these are independently associated with reduced HRQOL [11].

2. Current Insights

This prospective ongoing study is the first to assess sleep disorders among Romanian patients with CLDs by using actigraphy and correlate its results with subjective tools for sleep quality and HRQOL.
Sleep disorders have been previously described in patients with CLDs in several studies [8][10][11][12][13][14], where their prevalence varies widely from 47% to 81%, mainly due to different assessment methods, heterogenous population, and cumulative influencing/bias factors (e.g., coffee intake, alcohol, sleep medication, presence of hepatic encephalopathy, associated comorbidities, etc.). We reported in our study, among CLD patients, a prevalence of 48.21% of nighttime disturbances and 39.29% of daytime sleepiness, evaluated by PSQI and ESS, respectively. The scores for both questionnaires were significantly higher in decompensated patients, showing a direct relationship between impaired sleep quality and daytime somnolence, and complicated, severe liver disease. Excessive daytime sleepiness has been considered a feature of hepatic encephalopathy, since ESS score has been shown to correlate with the degree of hepatic encephalopathy [15][16][17][18]. Still, it's demonstrated that daytime somnolence is present in a high percentage even in pre-cirrhotic patients. This finding may indicate a possible early minimal hepatic encephalopathy (HE) before becoming clinically evident in patients with cirrhosis, however, of course, further prospective studies are needed to confirm this hypothesis.
In addition to the subjective data of sleep quality, objective measures of sleep characteristics were added by using actigraphy. Studies from the literature show that patients with cirrhosis, in particular, experience “delayed sleep phase syndrome” [19], with prolonged onset latency, poor sleep efficacy, and fragmented sleep with frequent awakenings [15][12][19]. This information is also supported by our study, which showed delayed bedtime and get-up hours, lower sleep efficacy, and also more awakenings in patients with cirrhosis compared to pre-cirrhotic ones. Controversially, our study failed to reveal significant differences of onset latency and total sleep time between pre-cirrhotic and cirrhotic patients, as the periods were similar. Moreover, our evidence shows that the difference in sleep parameters is even more important when comparing decompensated stages with compensated forms.
HRQOL in patients with CLDs is influenced by various factors. On one hand, patients experience multiple symptoms related to liver disease, such as itching, fatigue, weight loss, and “fuzzy-thinking”, which can also interfere with their social life. On the other hand, psychological distress strains on patients with advanced stages, when concerns regarding disease progression tremendously impact their QOL [20]. All these factors are also contributors to sleep abnormalities. However, researchers investigated the relationship between sleep impairment in patients with cirrhosis and HRQOL independently of other factors [11][15]. An important finding of our study showed that, besides cirrhotics, patients in pre-cirrhotic stages also experience reduced QOL, directly influenced by poor sleep quality.

References

  1. Haraldstad, K.; Wahl, A.; Andenæs, R.; Andersen, J.R.; Andersen, M.H.; Beisland, E.; Borge, C.R.; Engebretsen, E.; Eisemann, M.; Halvorsrud, L.; et al. A systematic review of quality of life research in medicine and health sciences. Qual. Life Res. 2019, 28, 2641–2650.
  2. Megari, K. Quality of life in chronic disease patients. Health Psychol. Res. 2013, 1, e27.
  3. Mayo, N. Dictionary of Quality of Life and Health Outcomes Measurement; International Society for Quality of Life Research: Milwaukee, WI, USA, 2015.
  4. Katulka, E.K.; Berube, F.R.; D’Agata, M.N. Dreaming of better health: Quantifying the many dimensions of sleep. Sleep 2019, 43, 275.
  5. Buysse, D.J. Sleep Health: Can We Define It? Does It Matter? Sleep 2014, 37, 9–17.
  6. Moon, A.M.; Singal, A.G.; Tapper, E.B. Contemporary Epidemiology of Chronic Liver Disease and Cirrhosis. Clin. Gastroenterol. Hepatol. 2019, 18, 2650–2666.
  7. Plotogea, O.-M.; Ilie, M.; Bungau, S.; Chiotoroiu, A.; Stanescu, A.; Diaconu, C. Comprehensive Overview of Sleep Disorders in Patients with Chronic Liver Disease. Brain Sci. 2021, 11, 142.
  8. Formentin, C.; Garrido, M.; Montagnese, S. Assessment and Management of Sleep Disturbance in Cirrhosis. Curr. Hepatol. Rep. 2018, 17, 52–69.
  9. Shah, N.M.; Malhotra, A.M.; Kaltsakas, G. Sleep disorder in patients with chronic liver disease: A narrative review. J. Thorac. Dis. 2020, 12 (Suppl. S2), S248–S260.
  10. Umbro, I.; Fabiani, V.; Fabiani, M.; Angelico, F.; Del Ben, M. Association between non-alcoholic fatty liver disease and obstructive sleep apnea. World J. Gastroenterol. 2020, 26, 2669–2681.
  11. Ghabril, M.; Jackson, M.; Gotur, R.; Weber, R.; Orman, E.; Vuppalanchi, R.; Chalasani, N. Most Individuals with Advanced Cirrhosis Have Sleep Disturbances, Which Are Associated with Poor Quality of Life. Clin. Gastroenterol. Hepatol. 2017, 15, 1271–1278.e6.
  12. Córdoba, J.; Cabrera, J.; Lataif, L.; Penev, P.; Zee, P.; Blei, A.T. High prevalence of sleep disturbance in cirrhosis. Hepatology 1998, 27, 339–345.
  13. AL-Jahdali, H.; Al Enezi, A.; Anwar, A.E.; AL-Harbi, A.; Baharoon, S.; Aljumah, A.; Shimemeri, A.; Abudallah, K. Preva-lence of insomnia and sleep patterns among liver cirrhosis patients. J. Circadian Rhythm. 2014, 12, 1–6.
  14. Abdullah, A.E.; Al-Jahdali, F.; Ahmed, A.E.; Shirbini, N.; Salim, B.; Ali, Y.Z.; Abdulrahman, A.; Khan, M.; Khaleid, A.; Hamdan, A.-J. Symptoms of Daytime Sleepiness and Sleep Apnea in Liver Cirrhosis Patients. Ann. Hepatol. 2017, 16, 591–598.
  15. Montagnese, S.; Middleton, B.; Skene, D.; Morgan, M.Y. Night-time sleep disturbance does not correlate with neuropsychiatric impairment in patients with cirrhosis. Liver Int. 2009, 29, 1372–1382.
  16. Samanta, J.; Dhiman, R.K.; Khatri, A.; Thumburu, K.K.; Grover, S.; Duseja, A.; Chawla, Y. Correlation between degree and quality of sleep disturbance and the level of neuropsychiatric impairment in patients with liver cirrhosis. Metab. Brain Dis. 2013, 28, 249–259.
  17. De Rui, M.; Schiff, S.; Aprile, D.; Angeli, P.; Bombonato, G.; Bolognesi, M.; Sacerdoti, D.; Gatta, A.; Merkel, C.; Amodio, P.; et al. Excessive daytime sleepiness and hepatic encephalopathy: It is worth asking. Metab. Brain Dis. 2013, 28, 245–248.
  18. Mostacci, B.; Ferlisi, M.; Antognini, A.B.; Sama, C.; Morelli, C.; Mondini, S.; Cirignotta, F. Sleep Disturbance and Daytime Sleepiness in Patients with Cirrhosis: A Case Control Study. Neurol. Sci. 2008, 29, 237–240.
  19. Montagnese, S.; Middleton, B.; Mani, A.R.; Skene, D.J.; Morgan, M.Y. Sleep and circadian abnormalities in patients with cir-rhosis: Features of delayed sleep phase syndrome? Metab. Brain Dis. 2009, 24, 427–439.
  20. Loria, A.; Escheik, C.; Gerber, L.; Younossi, Z.M. Quality of Life in Cirrhosis. Curr. Gastroenterol. Rep. 2012, 15, 301.
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Subjects: Gastroenterology & Hepatology; Neurosciences
Contributor MDPI registered users' name will be linked to their SciProfiles pages. To register with us, please refer to https://encyclopedia.pub/register :
Camelia Diaconu
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Update Date: 09 Jan 2022
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