title: Sleep disturbances in patients of liver cirrhosis with minimal hepatic encephalopathy before and after lactulose therapy.
abstract: Sleep disturbances are common in patients of cirrhosis with minimal hepatic encephalopathy (MHE) and affect health related quality of life (HRQOL). No study has evaluated effect of lactulose on sleep disturbances and correlation with HRQOL in patients with MHE. We assessed sleep disturbances in cirrhosis with MHE and effect of lactulose on sleep disturbances and HRQOL. One hundred patients of cirrhosis [MHE; (n = 50, age 45.3 ± 11.2 years, 45 males) no-MHE (n = 50, age 46.3 ± 10.4 years, 44 males)] were included. MHE was diagnosed with psychometric hepatic encephalopathy score (PHES) ≤ -5. All patients underwent laboratory parameters including arterial ammonia and critical flicker frequency (CFF) Sleep disturbances were measured with Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and polysomnography. HRQOL was measured with SF-36(v2) questionnaire. Patients with MHE were given lactulose therapy for 3 months and all the parameters were repeated. Poor quality of sleep and excessive day time sleepiness were more common in patients with MHE, compared to without MHE. With lactulose therapy there was improvement in MHE in 21 patients and arterial ammonia levels (93.74 ± 14.8 vs. 71.44 ± 18.8 μmol/L: p < 0.001), CFF (34.83 ± 3.54 vs. 39.44 ± 4.95 Hz: p < 0.001), PHES (-7.64 ± 2.1 vs. -5.58 ± 2.09: p < 0.001), PSQI (8.6 ± 3.3 vs. 5.2 ± 1.5: p < 0.001), ESS (12.52 ± 3.01 vs. 9.24 ± 2.27: p < 0.001) and HRQOL (p = 0.01). Excessive day time sleepiness and impaired sleep quality are common in patients with MHE and correlate with neuropsychiatric impairment. Improvement in MHE with lactulose also leads to improvement in sleep disturbances and HRQOL.
authors.affiliation: Department of Gastroenterology, G. B. Pant Institute of Postgraduate Medical Education and Research, JLN Marg, New Delhi, 110002, India.
authors.forename: Jatinderpal
authors.initials: J
authors.lastname: Singh
authors.affiliation: Department of Gastroenterology, G. B. Pant Institute of Postgraduate Medical Education and Research, JLN Marg, New Delhi, 110002, India. drbcsharma@hotmail.com.
authors.forename: Barjesh Chander
authors.initials: BC
authors.lastname: Sharma
authors.affiliation: Department of Neurology, G. B. Pant Institute of Postgraduate Medical Education and Research, JLN Marg, New Delhi, 110002, India.
authors.forename: Vinod
authors.initials: V
authors.lastname: Puri
authors.affiliation: Department of Gastroenterology, G. B. Pant Institute of Postgraduate Medical Education and Research, JLN Marg, New Delhi, 110002, India.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Sachdeva
authors.affiliation: Department of Gastroenterology, G. B. Pant Institute of Postgraduate Medical Education and Research, JLN Marg, New Delhi, 110002, India.
authors.forename: Siddharth
authors.initials: S
authors.lastname: Srivastava
mesh_terms: D000328:Adult; D000641:Ammonia / Q000097:blood; D006970:Disorders of Excessive Somnolence / Q000188:drug therapy / Q000209:etiology; D005260:Female; D005425:Flicker Fusion; D006501:Hepatic Encephalopathy / Q000150:complications* / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D007792:Lactulose / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000150:complications* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D017286:Polysomnography; D011594:Psychometrics; D011788:Quality of Life; D012893:Sleep Wake Disorders / Q000188:drug therapy* / Q000209:etiology* / Q000523:psychology; D016896:Treatment Outcome
chemical_list: D007792:Lactulose; D000641:Ammonia
keywords: Hepatic encephalopathy; Lactulose