title: Excessive daytime sleepiness and hepatic encephalopathy: it is worth asking.
abstract: The relationship between hepatic encephalopathy (HE) and the sleep-wake disturbances exhibited by patients with cirrhosis remains debated. The aim of this study was to examine the usefulness of sleep-wake interview within the context of HE assessment. One-hundred-and-six cirrhotic patients were asked three yes/no questions investigating the presence of difficulty falling asleep, night awakenings and daytime sleepiness. All underwent formal HE assessment, quantitative electroencephalography and standardised psychometry. Fifty-eight were monitored for 8 ± 6 months in relation to the occurrence of HE. Patients complaining of daytime sleepiness (n = 75, 71 %) had slower EEGs than those who did not report it (relative alpha power: 37 ± 19 vs. 48 ± 17 %, p < 0.05). In addition, daytime sleepiness was associated with the presence of portal-systemic shunt (79 vs. 57 %, p < 0.05) and HE history (72 vs. 45 %, p < 0.05). Finally, the absence of excessive daytime sleepiness had a Negative Predictive Value of 92 % (64-100) in relation to the development of HE during the follow-up period. These data support the appropriateness of adding a yes/no question on the presence of excessive daytime sleepiness to routine assessment of patients with cirrhosis, to help identify those who do not need further, formal HE screening.
authors.affiliation: Department of Medicine, University of Padova, Padova, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: De Rui
authors.forename: Sami
authors.initials: S
authors.lastname: Schiff
authors.forename: Daniele
authors.initials: D
authors.lastname: Aprile
authors.forename: Paolo
authors.initials: P
authors.lastname: Angeli
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Bombonato
authors.forename: Massimo
authors.initials: M
authors.lastname: Bolognesi
authors.forename: David
authors.initials: D
authors.lastname: Sacerdoti
authors.forename: Angelo
authors.initials: A
authors.lastname: Gatta
authors.forename: Carlo
authors.initials: C
authors.lastname: Merkel
authors.forename: Piero
authors.initials: P
authors.lastname: Amodio
authors.forename: Sara
authors.initials: S
authors.lastname: Montagnese
mesh_terms: D000368:Aged; D006970:Disorders of Excessive Somnolence / Q000209:etiology*; D005260:Female; D006501:Hepatic Encephalopathy / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011594:Psychometrics; D012890:Sleep / Q000502:physiology; D012893:Sleep Wake Disorders / Q000209:etiology / Q000523:psychology; D016019:Survival Analysis; D014851:Wakefulness / Q000502:physiology