title: Effect of an oral branched chain amino acid-enriched snack in cirrhotic patients with sleep disturbance.
abstract: OBJECTIVE
  Sleep is closely related to physical and mental health. Sleep disturbance is reported in patients without encephalopathy. We examined the relationship among cirrhotic symptoms, laboratory data and sleep disturbances. Next, we examined the influence of a branched chain amino acid (BCAA) supplement on sleep disturbance in cirrhotic patients.
  
  
  METHODS
  We investigated a total of 21 patients at Nagasaki University Hospital from January to June 2009. We constructed questionnaire items for the evaluation of cirrhotic symptoms. The items, as major symptoms of cirrhotic patients, were as follows: hand tremor, appetite loss, muscle cramp of foot, fatigue, decreased strength, anxiety, abdominal fullness, abdominal pain and a feeling of low energy. We used the Epworth Sleepiness Scale (ESS) for the evaluation of daytime hypersomnolence. Energy supplementation with a BCAA snack was performed as a late evening snack (LES). All patients were assessed at the time of entry into the study, and at 4 and 8 weeks.
  
  
  RESULTS
  It was found that BCAA snack, taken p.o. as an LES, improved the ESS for cirrhotic patients without encephalopathy. This beneficial result was recognized in the short term, 4 weeks after beginning of treatment. This study demonstrated the utility of BCAA supplementation for cirrhotic patients with sleep disturbance. However, the cirrhotic symptom-related score was positively relation with the Child-Pugh score at the time of patient entry, and we were unable to identify the item that related to ESS.
  
  
  CONCLUSIONS
  A BCAA snack is a useful drug for cirrhotic patients who do not have any overt encephalopathy, but who suffered from sleep disturbance.
authors.affiliation: Department of Gastroenterology and Hepatology, Graduate School of Biomedical Sciences, Nagasaki University Department of Endoscopy, Nagasaki University Hospital, Nagasaki, Japan.
authors.forename: Tatsuki
authors.initials: T
authors.lastname: Ichikawa
authors.forename: Taura
authors.initials: T
authors.lastname: Naota
authors.forename: Hisamitsu
authors.initials: H
authors.lastname: Miyaaki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Miuma
authors.forename: Hajime
authors.initials: H
authors.lastname: Isomoto
authors.forename: Fuminao
authors.initials: F
authors.lastname: Takeshima
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nakao