title: The association of insomnia with gastroesophageal reflux symptoms in biopsy-proven nonalcoholic fatty liver disease.
abstract: BACKGROUND
  It is suggested that nonalcoholic fatty liver disease (NAFLD), including nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH), can be associated with insomnia and gastro-esophageal reflux disease (GERD). The relationship between GERD and insomnia in subjects with biopsy-proven NAFLD was investigated.
  
  
  METHODS
  This study enrolled 123 patients with biopsy-proven NAFLD. Insomnia was assessed by the Athens Insomnia Scale (AIS), a self-assessment psychometric instrument designed to quantify sleep difficulty based on ICD-10 criteria; AIS scores ≥ 6 were considered positive for insomnia. GERD symptoms were evaluated using a frequency scale for the symptoms of GERD (FSSG); FSSG scores ≥ 8 were considered positive. Logistic regression models were used to evaluate the association of insomnia with GERD, after adjusting for potential confounders. Thirteen patients with GERD were treated with the proton pump inhibitor rabeprazole (RPZ; 10 mg/day), for 12 weeks.
  
  
  RESULTS
  Of the 123 patients, 76 (62%) were female and 87 (71%) were obese, with 34 (28%) having AIS scores ≥ 6 and 31 (25%) having FSSG scores ≥ 8. Liver biopsy revealed that 40 patients (33%) had NAFL and 83 (67%) had NASH. FSSG and AIS scores were similar in the two groups. HOMA-IR, FSSG scores and γGT (GGT) concentrations were significantly higher in insomniacs than in non-insomniacs. Logistic regression analysis demonstrated that FSSG score and GGT concentration were independently associated with insomnia. RPZ treatment resulted in significantly reductions in both AIS and FSSG scores.
  
  
  CONCLUSIONS
  Nearly 30% of patients with biopsy-proven NAFLD had insomnia, which was related to GGT and GERD and could be relieved by RPZ treatment.
authors: Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan.
authors: Hiroyoshi
authors: H
authors: Taketani
authors: Yoshio
authors: Y
authors: Sumida
authors: Saiyu
authors: S
authors: Tanaka
authors: Kento
authors: K
authors: Imajo
authors: Masato
authors: M
authors: Yoneda
authors: Hideyuki
authors: H
authors: Hyogo
authors: Masafumi
authors: M
authors: Ono
authors: Hideki
authors: H
authors: Fujii
authors: Yuichiro
authors: Y
authors: Eguchi
authors: Kazuyuki
authors: K
authors: Kanemasa
authors: Kazuaki
authors: K
authors: Chayama
authors: Yoshito
authors: Y
authors: Itoh
authors: Toshikazu
authors: T
authors: Yoshikawa
authors: Toshiji
authors: T
authors: Saibara
authors: Kazuma
authors: K
authors: Fujimoto
authors: Atsushi
authors: A
authors: Nakajima
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D009765:Obesity / Q000150:complications / Q000453:epidemiology; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D011594:Psychometrics; D064750:Rabeprazole / Q000627:therapeutic use; D012720:Severity of Illness Index; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology / Q000209:etiology*; D055815:Young Adult
chemical_list: D054328:Proton Pump Inhibitors; D064750:Rabeprazole
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