title: Improvement of sleep architecture parameters in cirrhotic patients with recurrent hepatic encephalopathy with the use of rifaximin.
abstract: OBJECTIVE
  Sleep disorders are frequently reported in patients with cirrhosis and hepatic encephalopathy (HE). This study assessed the effect of rifaximin on sleep architecture parameters in patients with recurrent HE.
  
  
  METHODS
  This sequential, prospective, and exploratory study involved all patients with cirrhosis and recurrent HE admitted between June 2014 and September 2015. HE was assessed according to the West-Haven Classification. Patients underwent 24-h polysomnography (PSG) and 7-day actigraphy. Rapid eye movement (REM) sleep was considered to be an indicator of good sleep quality. Patients completed questionnaires assessing the quality of sleep and sleepiness. After a 28-day course of rifaximin, the same assessment was repeated.
  
  
  RESULTS
  Fifteen patients were included (nine men, mean age: 57±11 years). Child-Pugh scores ranged from B7 to C15. Before rifaximin, the mean HE score was 2.7±0.7. Data from PSG analysis indicated long total sleep time (TST): 571±288 min, and limited REM sleep: 2.5% TST (0-19). Seven-day actigraphy showed an impaired number of steps: 1690/24 h (176-6945). Questionnaires indicated that patients experienced impaired sleep quality and excessive daytime sleepiness. After rifaximin, HE scores decreased to 1.7±0.6 (P<0.001). REM sleep increased to 8.5% TST (0-25) (P=0.003). No changes were observed for TST, number of steps, and on questionnaires.
  
  
  CONCLUSIONS
  Patients with recurrent HE suffer from poor sleep quality and excessive daytime sleepiness. On 24-h PSG, rifaximin improves objective sleep architecture parameters with no changes in the subjective quality of sleep and sleepiness.
authors.affiliation: aSleep Unit, Department of Pneumology bDepartment of Hepatogastroenterology, Saint-Pierre University Hospital cDepartment of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital dData Centre, Jules Bordet Institute eDepartment of Neurology, UMC Brugmann fLaboratory of Experimental Gastroenterolgy, Université Libre de Bruxelles, Brussels, Belgium gInserm Unité 1149, Center for Research on Inflammation (CRI) hUMR S_1149, Paris Diderot University, Paris, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Bruyneel
authors.forename: Thomas
authors.initials: T
authors.lastname: Sersté
authors.forename: Walter
authors.initials: W
authors.lastname: Libert
authors.forename: Sandra
authors.initials: S
authors.lastname: van den Broecke
authors.forename: Lieveke
authors.initials: L
authors.lastname: Ameye
authors.forename: Bernard
authors.initials: B
authors.lastname: Dachy
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Mulkay
authors.forename: Christophe
authors.initials: C
authors.lastname: Moreno
authors.forename: Thierry
authors.initials: T
authors.lastname: Gustot
mesh_terms: D056044:Actigraphy; D000204:Activity Cycles / Q000187:drug effects; D000339:Affect / Q000187:drug effects; D000368:Aged; D001530:Belgium; D005260:Female; D006501:Hepatic Encephalopathy / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011446:Prospective Studies; D011788:Quality of Life; D012008:Recurrence; D012294:Rifamycins / Q000009:adverse effects / Q000627:therapeutic use*; D000078262:Rifaximin; D000068776:Sleep Aids, Pharmaceutical / Q000009:adverse effects / Q000627:therapeutic use*; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D012895:Sleep, REM / Q000187:drug effects*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D012294:Rifamycins; D000068776:Sleep Aids, Pharmaceutical; D000078262:Rifaximin