Kumar Akash, Gupta Ravi, Gupta Rohit
All India Institute of Medical Sciences, Psychiatry - Dehradun - Uttarakhand - India.
All India Institute of Medical Sciences, Gastroenterology - Dehradun - Uttrakhand - India.
Sleep Sci. 2021 Jul-Sep;14(3):266-272. doi: 10.5935/1984-0063.20200060.
Previously done studies have shown that 39.6%-81% of subjects with chronic liver disease (CLD) report poor sleep quality and 42% experience insomnia. However, despite the high prevalence of insomnia and poor sleep quality in this group of patients, literature is scanty. In addition, previous studies have not ruled out subjects with restless legs syndrome, which is seen in a sizable number of subjects having CLD.
Adult patients with a clinical diagnosis of CLD were included after excluding potential confounders. The etiology of CLD was investigated. The severity of liver disease was assessed and graded as Child-Turcotte-Pugh (CTP) class A, B or C; model for end-stage liver disease (MELD) score and as the presence of compensated or decompensated liver disease. Acute on chronic liver failure was also defined as per APASL criteria. For the present study, subjects having a score greater than 14 on insomnia severity index along with clinical diagnosis (DSM-5) were considered as having insomnia. Depression was diagnosed using a patient health questionnaire (PHQ-9) along with clinical criteria following DSM-5. Sleep quality was assessed by the Pittsburg sleep quality index - Hindi version. RLS was diagnosed on clinical interview and examination. The severity of RLS was assessed using international RLS severity rating scales.
This cross-sectional study included 131 subjects. This sample had a predominance of males (78.6%), the average age of subjects was 48.70+12.31 years and 98.5% of subjects had decompensated liver disease. 54.2% had a history of alcohol use disorder and 45% had a history of nicotine use disorder. The prevalence of hepatitis B and C infection was 16.8% and 23.7%, respectively. Acute on chronic liver failure was observed in 22.9% of subjects. 19.8% of subjects had acute kidney injury. Poor sleep quality was reported by 37.4% of subjects in this study which was higher than population prevalence (p<0.001). Subjects with poor sleep quality had a higher proportion of insomnia, RLS, and depression. 19.8% of subjects reported insomnia in the present study and depressive symptoms were more severe among subjects with insomnia. RLS was reported by 19.1% of subjects and 2.3% had a positive family history of RLS. However, there was no difference in sleep quality and insomnia in patients with or without RLS.
The present study shows that insomnia and poor sleep quality are more prevalent among patients with CLD. Sleep disturbance is associated with depressive symptoms and can worsen the quality of life.
先前的研究表明，39.6%-81%的慢性肝病（CLD）患者报告睡眠质量差，42%的患者存在失眠。然而，尽管该组患者中失眠和睡眠质量差的患病率很高，但相关文献却很少。此外，先前的研究并未排除不安腿综合征患者，而在大量CLD患者中可观察到该综合征。
排除潜在混杂因素后，纳入临床诊断为CLD的成年患者。对CLD的病因进行调查。评估肝病的严重程度并分为Child-Turcotte-Pugh（CTP）A、B或C级；终末期肝病模型（MELD）评分以及是否存在代偿期或失代偿期肝病。还根据亚太肝脏研究协会（APASL）标准定义慢性肝衰竭急性发作。在本研究中，失眠严重程度指数得分大于14且有临床诊断（DSM-5）的受试者被视为患有失眠。使用患者健康问卷（PHQ-9）并遵循DSM-5临床标准诊断抑郁症。通过匹兹堡睡眠质量指数 - 印地语版评估睡眠质量。通过临床访谈和检查诊断不安腿综合征（RLS）。使用国际RLS严重程度评定量表评估RLS的严重程度。
这项横断面研究纳入了131名受试者。该样本以男性为主（78.6%），受试者的平均年龄为48.70±12.31岁，98.5%的受试者患有失代偿期肝病。54.2%的受试者有酒精使用障碍史，45%的受试者有尼古丁使用障碍史。乙型和丙型肝炎感染的患病率分别为16.8%和23.7%。22.9%的受试者观察到慢性肝衰竭急性发作。19.
