Excessive daytime sleepiness and hepatic encephalopathy: it is worth asking
Excessive daytime sleepiness and hepatic encephalopathy: it is worth asking
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DOI：
10.1007/s11011-012-9360-4
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发表时间：
2013-06-01
影响因子：
3.6
通讯作者：
Montagnese, Sara
中科院分区：
文献类型：
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作者：
De Rui, Michele;Schiff, Sami;Montagnese, Sara
肝硬化患者表现出肝性脑病（HE）与睡眠效果障碍之间的关系仍然存在争议。这项研究的目的是检查在评估的背景下睡眠觉醒访谈的有用性。一百六十六个肝硬化患者被询问三个是/否问题，以调查难以入睡，夜间觉醒和白天嗜睡的困难。所有人都接受了正式评估，定量脑电图和标准化心理测量学。相对于HE的发生，对58次监测了8 +/- 6个月。抱怨白天嗜睡的患者（n = 75，71％）的脑电图比没有报告的患者慢（相对α功率：37 +/- 19 vs. 48 +/- 17％，p <0.05）。此外，白天的嗜睡与门户系统分流的存在有关（79 vs. 57％，p <0.05）和HE历史（72 vs. 45％，p <0.05）。最后，在随访期间，缺乏白天嗜睡过多的预测值为92％（64-100）。这些数据支持适当的添加是/否质疑白天过度嗜睡以常规评估肝硬化患者的问题，以帮助确定那些不需要进一步，正式筛查的人。
The relationship between hepatic encephalopathy (HE) and the sleep-wake disturbances exhibited by patients with cirrhosis remains debated. The aim of this study was to examine the usefulness of sleep-wake interview within the context of HE assessment. One-hundred-and-six cirrhotic patients were asked three yes/no questions investigating the presence of difficulty falling asleep, night awakenings and daytime sleepiness. All underwent formal HE assessment, quantitative electroencephalography and standardised psychometry. Fifty-eight were monitored for 8 +/- 6 months in relation to the occurrence of HE. Patients complaining of daytime sleepiness (n = 75, 71 %) had slower EEGs than those who did not report it (relative alpha power: 37 +/- 19 vs. 48 +/- 17 %, p < 0.05). In addition, daytime sleepiness was associated with the presence of portal-systemic shunt (79 vs. 57 %, p < 0.05) and HE history (72 vs. 45 %, p < 0.05). Finally, the absence of excessive daytime sleepiness had a Negative Predictive Value of 92 % (64-100) in relation to the development of HE during the follow-up period. These data support the appropriateness of adding a yes/no question on the presence of excessive daytime sleepiness to routine assessment of patients with cirrhosis, to help identify those who do not need further, formal HE screening.