Plotogea Oana-Mihaela, Diaconu Camelia Cristina, Gheorghe Gina, Stan-Ilie Madalina, Badea Mircea-Alexandru, Prelipcean Cristina Cijevschi, Constantinescu Gabriel
Department 5, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Department of Gastroenterology, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania.
Brain Sci. 2022 Mar 26;12(4):444. doi: 10.3390/brainsci12040444.
Introduction/Aim. The aim of this study was to assess the prevalence of cognitive impairments and their association with sleep patterns in a cohort of patients diagnosed with chronic liver disease (CLD). Material and methods. The present paper is a prospective cohort study, carried out over a period of 12 months, among patients with various stages of CLD. We evaluated the cognitive function through psychometric hepatic encephalopathy score (PHES), while sleep was assessed by actigraphy and two self-reported questionnaires: Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). Results. Seventy-four patients with CLD were considered eligible and were enrolled between December 2020−November 2021. The prevalence of minimal hepatic encephalopathy (MHE) in the entire cohort was 41.9%, and the diagnosis was considered for PHES scores ≤ −3. Patients with cirrhosis recorded significantly lower PHES scores compared to patients with other CLDs but without cirrhosis (−3.19 ± 3.89 vs. 0.19 ± 2.92, p < 0.05). Patients who exhibited MHE suffered from poor sleep, daytime somnolence, disturbed nighttime sleep, and low overall sleep efficacy. Patients diagnosed with MHE and undergoing treatment with lactulose and/or rifaximin for prevention of overt hepatic encephalopathy (HE) showed better results in terms of sleep parameters compared to patients diagnosed with MHE but without treatment. Conclusions. This research increases awareness regarding the connection between sleep features and MHE in patients with cirrhosis and other CLDs. A deeper insight into the subclinical stages of HE and associated sleep disturbances is warranted in future studies.
引言/目的。本研究旨在评估一组被诊断为慢性肝病（CLD）的患者中认知障碍的患病率及其与睡眠模式的关联。材料与方法。本文是一项前瞻性队列研究，在12个月的时间里对不同阶段的CLD患者进行。我们通过心理测量肝性脑病评分（PHES）评估认知功能，同时通过活动记录仪以及两份自我报告问卷：爱泼华嗜睡量表（ESS）和匹兹堡睡眠质量指数（PSQI）评估睡眠。结果。74例CLD患者被认为符合条件并于2020年12月至2021年11月期间入组。整个队列中轻微肝性脑病（MHE）的患病率为41.9%，当PHES评分≤ -3时考虑诊断为MHE。与其他无肝硬化的CLD患者相比，肝硬化患者的PHES评分显著更低（-3.19 ± 3.89 vs. 0.19 ± 2.92，p < 0.05）。出现MHE的患者存在睡眠差、白天嗜睡、夜间睡眠紊乱以及总体睡眠效率低的问题。与未接受治疗的MHE诊断患者相比，接受乳果糖和/或利福昔明治疗以预防显性肝性脑病（HE）的MHE诊断患者在睡眠参数方面表现更好。结论。本研究提高了对肝硬化和其他CLD患者睡眠特征与MHE之间联系的认识。未来研究有必要更深入地了解HE的亚临床阶段及相关睡眠障碍。
