Most Individuals With Advanced Cirrhosis Have Sleep Disturbances, Which Are Associated With Poor Quality of Life
Most Individuals With Advanced Cirrhosis Have Sleep Disturbances, Which Are Associated With Poor Quality of Life
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DOI：
10.1016/j.cgh.2017.01.027
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发表时间：
2017-08-01
影响因子：
12.6
通讯作者：
Chalasani, Naga
中科院分区：
文献类型：
--
作者：
Ghabril, Marwan;Jackson, Mollie;Chalasani, Naga
背景与目的：睡眠障碍在肝硬变患者中很常见，但其决定因素和对健康相关生活质量的影响尚不清楚。我们调查了这些患者中睡眠障碍的发生率，与睡眠障碍相关的因素，以及对生活质量的影响。方法：我们对193名稳定的门诊肝硬化患者(154名失代偿期肝硬化患者)进行了前瞻性横断面研究。参与者完成了匹兹堡睡眠质量指数(评估睡眠质量)、慢性肝病问卷(CLDQ)和肌肉痉挛问卷，并接受了神经认知测试。对睡眠正常和睡眠紊乱的一组患者进行了肌动描记。结果：在研究对象中，157人(81%)有睡眠障碍，匹兹堡睡眠质量指数评分为5。根据CLDQ评分，睡眠障碍与肌肉痉挛、日间嗜睡和生活质量下降有关。Logistic回归分析中与睡眠障碍独立相关的因素包括低蛋白血症、阿片类药物治疗和肌肉痉挛。睡眠障碍与CLDQ评分(相关参数，-36.6；95%可信区间，-24~-49；P<；.001)线性回归独立相关。睡眠障碍与神经认知障碍有关，通过活动记录仪测量，睡眠时间显著延迟，总睡眠时间减少。睡眠障碍与肠道微生物群、脂质、精氨酸和尿素循环代谢改变的代谢组特征有关。结论：大多数晚期肝硬变患者(81%)有睡眠障碍。这对生活质量有负面影响，并与几种代谢途径的中断有关，包括肠道微生物区系的代谢。
BACKGROUND & AIMS: Sleep disturbances are common in patients with cirrhosis, but their determinants and effects on health-related quality of life are not well-understood. We investigated the prevalence of disturbed sleep in these patients, factors associated with sleep disruption, and effects on quality of life.METHODS: We performed a prospective, cross-sectional study of 193 stable ambulatory patients with cirrhosis (154 with decompensated cirrhosis). Participants completed the Pittsburgh Sleep Quality Index (to assess sleep quality), the Chronic Liver Disease Questionnaire (CLDQ), and muscle cramp questionnaires and underwent neurocognitive testing. Actigraphy was performed in a subset of patients with normal and disturbed sleep. We collected serum samples from subjects with normal and disturbed sleep and performed non-targeted metabolomic analyses.RESULTS: Of the study subjects, 157 (81%) had disturbed sleep, with Pittsburgh Sleep Quality Index scores >5. Disturbed sleep was associated with muscle cramps, daytime somnolence, and decreased quality of life on the basis of CLDQ scores. Factors independently associated with disturbed sleep in logistic regression analysis included hypoalbuminemia, opiate therapy, and muscle cramps. Disturbed sleep was independently associated with CLDQ score (correlation parameter, -36.6; 95% confidence interval, -24 to -49; P < .001) on linear regression. Disturbed sleep was associated with neurocognitive impairment and with significantly delayed bedtime and decreased total sleep time, measured by actigraphy. Disturbed sleep was associated with metabolome signatures of alterations to the intestinal microbiome and lipid, arginine, and urea cycle metabolism.CONCLUSIONS: Most patients with advanced cirrhosis (81%) have disturbed sleep. This has negative effects on quality of life and is associated with disruptions of several metabolic pathways, including metabolism by the intestinal microbiota.