Singh Jatinderpal, Sharma Barjesh Chander, Puri Vinod, Sachdeva Sanjeev, Srivastava Siddharth
Department of Gastroenterology, G. B. Pant Institute of Postgraduate Medical Education and Research, JLN Marg, New Delhi, 110002, India.
Department of Neurology, G. B. Pant Institute of Postgraduate Medical Education and Research, JLN Marg, New Delhi, 110002, India.
Metab Brain Dis. 2017 Apr;32(2):595-605. doi: 10.1007/s11011-016-9944-5. Epub 2017 Jan 9.
Sleep disturbances are common in patients of cirrhosis with minimal hepatic encephalopathy (MHE) and affect health related quality of life (HRQOL). No study has evaluated effect of lactulose on sleep disturbances and correlation with HRQOL in patients with MHE. We assessed sleep disturbances in cirrhosis with MHE and effect of lactulose on sleep disturbances and HRQOL. One hundred patients of cirrhosis [MHE; (n = 50, age 45.3 ± 11.2 years, 45 males) no-MHE (n = 50, age 46.3 ± 10.4 years, 44 males)] were included. MHE was diagnosed with psychometric hepatic encephalopathy score (PHES) ≤ -5. All patients underwent laboratory parameters including arterial ammonia and critical flicker frequency (CFF) Sleep disturbances were measured with Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and polysomnography. HRQOL was measured with SF-36(v2) questionnaire. Patients with MHE were given lactulose therapy for 3 months and all the parameters were repeated. Poor quality of sleep and excessive day time sleepiness were more common in patients with MHE, compared to without MHE. With lactulose therapy there was improvement in MHE in 21 patients and arterial ammonia levels (93.74 ± 14.8 vs. 71.44 ± 18.8 μmol/L: p < 0.001), CFF (34.83 ± 3.54 vs. 39.44 ± 4.95 Hz: p < 0.001), PHES (-7.64 ± 2.1 vs. -5.58 ± 2.09: p < 0.001), PSQI (8.6 ± 3.3 vs. 5.2 ± 1.5: p < 0.001), ESS (12.52 ± 3.01 vs. 9.24 ± 2.27: p < 0.001) and HRQOL (p = 0.01). Excessive day time sleepiness and impaired sleep quality are common in patients with MHE and correlate with neuropsychiatric impairment. Improvement in MHE with lactulose also leads to improvement in sleep disturbances and HRQOL.
睡眠障碍在伴有轻微肝性脑病（MHE）的肝硬化患者中很常见，并且会影响健康相关生活质量（HRQOL）。尚无研究评估乳果糖对MHE患者睡眠障碍的影响以及与HRQOL的相关性。我们评估了伴有MHE的肝硬化患者的睡眠障碍以及乳果糖对睡眠障碍和HRQOL的影响。纳入了100例肝硬化患者[MHE组；（n = 50，年龄45.3±11.2岁，男性45例）非MHE组（n = 50，年龄46.3±10.4岁，男性44例）]。MHE通过心理测量肝性脑病评分（PHES）≤ -5进行诊断。所有患者均接受了包括动脉血氨和临界闪烁频率（CFF）在内的实验室参数检测。使用匹兹堡睡眠质量指数（PSQI）、爱泼华嗜睡量表（ESS）和多导睡眠图测量睡眠障碍。使用SF-36（v2）问卷测量HRQOL。MHE患者接受了3个月的乳果糖治疗，并重复测量了所有参数。与非MHE患者相比，MHE患者睡眠质量差和白天过度嗜睡更为常见。经过乳果糖治疗，21例MHE患者的病情有所改善，动脉血氨水平（93.74±14.8 vs. 71.44±18.8 μmol/L：p < 0.001）、CFF（34.83±3.54 vs. 39.44±4.95 Hz：p < 0.001）、PHES（-7.64±2.1 vs. -5.58±2.09：p < 0.001）、PSQI（8.6±3.3 vs. 5.2±1.5：p < 0.001）、ESS（12.52±3.01 vs. 9.24±2.27：p < 0.001）和HRQOL（p = 0.01）均有所改善。白天过度嗜睡和睡眠质量受损在MHE患者中很常见，并且与神经精神损害相关。乳果糖改善MHE也会导致睡眠障碍和HRQOL的改善。
