Department of Medicine, Department of Veterans Affairs, Cincinnati, OH, USA.
Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Sleep Med. 2018 Jan;41:15-19. doi: 10.1016/j.sleep.2017.08.022. Epub 2017 Oct 12.
Questionnaires indicate that patients with liver disease have disturbed sleep. However, polysomnographic studies to quantify sleep architecture and sleep disorders in this population are lacking. The current study compared polysomnographic findings of two groups of patients with clinically stable but severe end-stage pathology of the liver and heart.
This was a prospective study of consecutive patients with end-stage liver disease or severe heart failure (HF).
Patients underwent full-night, attended polysomnography along with a number of laboratory tests. Polysomnograms were scored blindly. Compared to HF patients, patients with cirrhosis suffered from severe periodic limb movements during sleep (PLMS), with an index of 39/hour associated with excessive arousals. In patients with cirrhosis, serum iron and ferritin levels were either at the upper normal limit or elevated. There were significant correlations between severity of PLMS versus blood levels of bilirubin (r = 0.73, p = 0.004) and ammonia (r = 0.74, p = 0.017).
This was the first polysomnographic study of patients with stable cirrhosis demonstrating severely disturbed sleep infrastructure and presence of excessive PLMS with arousals. The pathobiochemical mechanisms of these findings remain to be established. Independent of the mechanisms, these polysomnographic findings confirmed the subjective reports of poor sleep by patients with cirrhosis. Further, a subset of patients with cirrhosis acquired a syndrome similar to idiopathic Parkinson's disease, which per se was frequently associated with PLMS; the current results were consistent with this notion. Future studies are needed to determine if PLMS of cirrhosis is an early indication of incident Parkinsonian syndrome.
问卷调查表明，肝病患者的睡眠质量受到了影响。然而，目前缺乏针对此类人群的睡眠结构和睡眠障碍的多导睡眠图研究。本研究比较了两组患有临床稳定但终末期肝脏和心脏疾病的患者的多导睡眠图结果。
这是一项对终末期肝病或严重心力衰竭（HF）患者的前瞻性研究。
患者接受了整夜、有多项实验室检查的多导睡眠图。多导睡眠图是盲法评分的。与 HF 患者相比，肝硬化患者在睡眠中出现严重的周期性肢体运动（PLMS），每小时 39 次的指数与过度觉醒有关。肝硬化患者的血清铁和铁蛋白水平要么处于正常上限，要么升高。PLMS 严重程度与胆红素（r=0.73，p=0.004）和氨（r=0.74，p=0.017）的血液水平之间存在显著相关性。
这是第一项针对稳定肝硬化患者的多导睡眠图研究，表明其睡眠结构严重受损，存在过多的导致觉醒的 PLMS。这些发现的病理生物化学机制仍有待确定。无论机制如何，这些多导睡眠图发现证实了肝硬化患者睡眠质量差的主观报告。此外，一部分肝硬化患者出现了类似于特发性帕金森病的综合征，而该病本身常与 PLMS 相关；本研究结果与这一观点一致。需要进一步的研究来确定肝硬化的 PLMS 是否是帕金森综合征的早期指标。
