title: Changes in sleep architecture and quality in minimal hepatic encephalopathy patients and relationship to psychological dysfunction.
abstract: OBJECTIVE
  We examined changes in sleep quality and architecture in patients with minimal hepatic encephalopathy (MHE) and the impacts of sleep disruption on patient physical and psychological health.
  
  
  METHODS
  Ninety-eight MHE patients were examined by polysomnography (PSG) and the Pittsburg sleep quality inventory (PSQI). In addition, patients completed the SAS, SDS, and SCL-90 to examine the relationship between sleep quality and psychological health.
  
  
  RESULTS
  Mean relative durations of Stage 1 and Stage 2, sleep latency, microarousal frequency, and total sleep time (TST) were all lower in MHE patients compared to healthy controls (P<0.05 for all). Similarly, SWS and REM stage durations, REM latency, sleep maintenance rate, and sleep efficiency were lower than controls (P<0.01 for all). Mean PSQI scores were lower in MHE patients. Total SAS, SDS, and SCL-90 scores, as well as all SCL-90 subscores, were significantly higher in the MHE group (P<0.05), indicating significant psychological dysfunction. Longer SWS, longer REM, and lower microarousal frequency were associated with improved sleep quality (P<0.05), while shorter SWS and REM led to dyssomnia and daytime functional disturbance (P<0.05, P<0.01). Longer REM latency and higher microarousal frequency were associated with higher PSQI scores (P<0.05, P<0.01), while longer SWS, longer REM, and higher sleep maintenance rate were associated with lower PSQI scores (P<0.05, P<0.01). Finally, total PSQI score and sleep efficiency subscore were positively correlated with total SCL-90 and most SCL-90 subscores (P<0.05).
  
  
  CONCLUSIONS
  MHE patients suffer from multiple subjective dyssomnias and changes in sleep architecture that are strongly correlated with psychological dysfunction.
authors.affiliation: No. 411 Hospital of CPLA Shanghai 200081, China.
authors.forename: Changyun
authors.initials: C
authors.lastname: Liu
authors.affiliation: No. 411 Hospital of CPLA Shanghai 200081, China.
authors.forename: Jianguang
authors.initials: J
authors.lastname: Zhou
authors.affiliation: No. 411 Hospital of CPLA Shanghai 200081, China.
authors.forename: Xuedong
authors.initials: X
authors.lastname: Yang
authors.affiliation: No. 411 Hospital of CPLA Shanghai 200081, China.
authors.forename: Jiao
authors.initials: J
authors.lastname: Lv
authors.affiliation: No. 411 Hospital of CPLA Shanghai 200081, China.
authors.forename: Yunxing
authors.initials: Y
authors.lastname: Shi
authors.affiliation: No. 411 Hospital of CPLA Shanghai 200081, China.
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Zeng
keywords: Minimal hepatic encephalopathy sleep architecture; pittsburgh sleep quality index; psychological symptoms