HIGH PREVALENCE OF SLEEP DISTURBANCE IN CIRRHOSIS

Sleep disturbance is a classic sign of hepatic encephalopathy, However , there are limited data regarding its prevalence in cirrhotic patient s without overt hepatic encephalopathy. We assessed the characteristic s of sleep in cirrhosis using a sleep questionnaire (n = 44) and actig raphy (n = 20). The results were compared with those of subjects with chronic renal failure and those of healthy controls. Presence of subcl inical hepatic encephalopathy, chronotypology profile, and individual' s affective state were also analyzed. The questionnaire indicated an e levated number of cirrhotic patients (47.7%) and patients with chronic renal failure (38.6%) who complained of unsatisfactory sleep compared with healthy controls (4.5%, P < .01). Actigraphy corroborated the de terioration of sleep parameters in cirrhotic patients with unsatisfact ory sleep. The sleep disturbance in cirrhosis was not associated with clinical parameters nor with cognitive impairment. Cirrhotic subjects and patients with chronic renal failure with unsatisfactory sleep show ed higher scores for depression and anxiety, raising the possibility t hat the effects of chronic disease may underlie the pathogenesis of sl eep disturbance. However, in contrast to chronic renal failure, unsati sfactory sleep in cirrhosis was associated with delayed bedtime, delay ed wake-up time, and evening chronotypology. In conclusion, a sleep di sturbance is frequent in cirrhotic patients without hepatic encephalop athy and may be related to abnormalities of the circadian timekeeping system.