Department of Pyshciatry, Division of Sleep Medicine, All India Institute of Medical Sciences, Rishikesh, 249203, India.
Department of Gastroenterology, All India Institute of Medical Sciences, Rishikesh, 249203, India.
Sleep Med Rev. 2021 Aug;58:101463. doi: 10.1016/j.smrv.2021.101463. Epub 2021 Mar 11.
Sleep disturbances are commonly reported in patients with chronic liver disease (CLD). Changes in quality of sleep in patients with CLD could be related to multiple factors viz., elevated levels of tryptophan, histamine, and increased turnover of dopamine in caudate-putamen and cingulate cortex. Also, iron metabolism disturbances are reported in patients with CLD. These changes may result in restless legs syndrome (RLS) that worsens sleep-quality. There have been reports suggesting an increased prevalence of RLS among patients with CLD. Literature was searched in PubMed, EMBASE, and Google Scholar. A total of twenty-two relevant articles were found. Out of these, nine studies have assessed the prevalence of RLS among patients with chronic liver disease or cirrhosis in the clinical population. Population prevalence reported from various studies was used to calculate odds ratio. Having included studies using various methods for diagnosis (clinical as well as questionnaires) pooled odds-ratio for the RLS was 8.62. It remains unaffected by study-method, gender, age, and geographical-area. However, studies using clinical diagnosis for RLS had lower odds compared to questionnaire based diagnosis. Studies varied with regards to diagnostic methods, age, gender, etiology, and severity of liver dysfunction. The severity and etiology of CLD and biochemical correlate of CLD were not found to be associated with RLS. Possible pathophysiological mechanisms are discussed for the occurrence of RLS in this population. In conclusion, the prevalence of RLS is higher among patients with CLD, however, the correlates are unknown.
睡眠障碍在慢性肝病（CLD）患者中很常见。CLD 患者睡眠质量的变化可能与多种因素有关，如色氨酸、组胺水平升高，以及尾状核和扣带回皮质中多巴胺的周转率增加。此外，CLD 患者还存在铁代谢紊乱。这些变化可能导致不宁腿综合征（RLS），从而使睡眠质量恶化。有报道称，CLD 患者中 RLS 的患病率增加。在 PubMed、EMBASE 和 Google Scholar 中进行了文献检索。共发现 22 篇相关文章。其中，有 9 项研究在临床人群中评估了慢性肝病或肝硬化患者中 RLS 的患病率。从各种研究中报告的人群患病率用于计算比值比。包括使用各种方法（临床和问卷）进行诊断的研究后，RLS 的汇总比值比为 8.62。它不受研究方法、性别、年龄和地理区域的影响。然而，使用临床诊断 RLS 的研究的几率比基于问卷的诊断低。研究在诊断方法、年龄、性别、病因和肝功能障碍严重程度方面存在差异。CLD 的严重程度和病因以及 CLD 的生化指标与 RLS 无关。为了探讨该人群中 RLS 发生的可能病理生理机制，对其进行了讨论。总之，CLD 患者的 RLS 患病率较高，但相关因素尚不清楚。
