Assessment of Sleep Pattern and Quality Before and After Liver Transplantation Using Different Methods

Overview

Journal Turk J Gastroenterol

Publisher Aves

Specialty Gastroenterology

Date 2020 Sep 11

PMID 32915146

Authors

Genco Gencdal

Gamze Turker

Isil Yazici Gencdal

Burcak Ekinci

Sencan Acar

Ayhan Dinckan

Murat Akyildiz

Affiliations

Soon will be listed here.

Abstract

Background/aims: Sleep disorders (SDs) are frequently seen in patients with liver cirrhosis. Polysomnography (PSG), actigraphy, and electroencephalogram (EEG) are the common objective methods to diagnose SDs. The most commonly used subjective methods are the Pittsburgh sleep quality index (PSQI) and Epworth sleepiness scale (ESS). We aimed to evaluate the effect of liver transplantation (LTx) on SDs using a combination of objective (PSG and EEG) and subjective (PSQI and ESS) methods.

Materials And Methods: A total of 18 patients with cirrhosis on an LTx waiting list were included in this study. Patient clinical status and biochemical parameters were evaluated. All patients completed the validated Turkish forms of the PSQI and ESS before and 9 months after LTx. All patients underwent EEG and PSG before and 9 months after LTx.

Results: In total, 18 patients with liver cirrhosis (men: 12; 66.7%, mean age: 53.22±10.43 years) were included in this study. Pretransplant mean PSQI and ESS scores were 8.4±3.11 and 7.28±3.89, respectively; 9-month posttransplant mean PSQI and ESS scores were 4.5±2.8 and 4.72±2.91 (p<0.01), respectively. Before transplantation, metabolic encephalopathy was detected in 6 patients by EEG, whereas metabolic encephalopathy was detected in only 1 patient posttransplant. Posttransplantation PSG sleep duration (all stages) increased relative to pretransplant PSG values. Sleep latency and rapid eye movement latency were found to be reduced compared to the pretransplant values.

Conclusion: This pilot study compared SDs in patients with pre- and post-LTx by combining the subjective and objective methods. Significant SD improvements were found at the 9th month.

Citing Articles

Investigation of Sleep Quality and Intolerance of Uncertainty in Liver Transplant Recipients: A Cross-Sectional Study.

Savsar A, Karayurt O, Kilic M, Kul G Nurs Health Sci. 2025; 27(1):e70029.

PMID: 39833657 PMC: 11752167. DOI: 10.1111/nhs.70029.

References

Hertenstein E, Gabryelska A, Spiegelhalder K, Nissen C, Johann A, Umarova R . Reference Data for Polysomnography-Measured and Subjective Sleep in Healthy Adults. J Clin Sleep Med. 2018; 14(4):523-532. PMC: 5886429. DOI: 10.5664/jcsm.7036. View

Samanta J, Dhiman R, Khatri A, Thumburu K, Grover S, Duseja A . Correlation between degree and quality of sleep disturbance and the level of neuropsychiatric impairment in patients with liver cirrhosis. Metab Brain Dis. 2013; 28(2):249-59. DOI: 10.1007/s11011-013-9393-3. View

Izci B, Ardic S, Firat H, Sahin A, Altinors M, Karacan I . Reliability and validity studies of the Turkish version of the Epworth Sleepiness Scale. Sleep Breath. 2007; 12(2):161-8. DOI: 10.1007/s11325-007-0145-7. View

Berry R, Budhiraja R, Gottlieb D, Gozal D, Iber C, Kapur V . Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2012; 8(5):597-619. PMC: 3459210. DOI: 10.5664/jcsm.2172. View

Ciancio A, Marchet A, Saracco G, Carucci P, Lavezzo B, Leotta D . Spectral electroencephalogram analysis in hepatic encephalopathy and liver transplantation. Liver Transpl. 2002; 8(7):630-5. DOI: 10.1053/jlts.2002.33971. View

Vilstrup H, Amodio P, Bajaj J, Cordoba J, Ferenci P, Mullen K . Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology. 2014; 60(2):715-35. DOI: 10.1002/hep.27210. View

Montagnese S, De Pitta C, De Rui M, Corrias M, Turco M, Merkel C . Sleep-wake abnormalities in patients with cirrhosis. Hepatology. 2013; 59(2):705-12. DOI: 10.1002/hep.26555. View

Mostacci B, Ferlisi M, Baldi Antognini A, Sama C, Morelli C, Mondini S . Sleep disturbance and daytime sleepiness in patients with cirrhosis: a case control study. Neurol Sci. 2008; 29(4):237-40. DOI: 10.1007/s10072-008-0973-7. View

Senzolo M, Marco S, Ferronato C, Cecilia F, Burra P, Patrizia B . Neurologic complications after solid organ transplantation. Transpl Int. 2008; 22(3):269-78. DOI: 10.1111/j.1432-2277.2008.00780.x. View

10.

Johns M . A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991; 14(6):540-5. DOI: 10.1093/sleep/14.6.540. View

11.

Cordoba J, Cabrera J, Lataif L, PENEV P, Zee P, Blei A . High prevalence of sleep disturbance in cirrhosis. Hepatology. 1998; 27(2):339-45. DOI: 10.1002/hep.510270204. View

12.

De Cruz S, Espiritu J, Zeidler M, Wang T . Sleep disorders in chronic liver disease. Semin Respir Crit Care Med. 2012; 33(1):26-35. DOI: 10.1055/s-0032-1301732. View

13.

Buysse D, Reynolds 3rd C, Monk T, BERMAN S, Kupfer D . The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989; 28(2):193-213. DOI: 10.1016/0165-1781(89)90047-4. View

14.

Xiao G, Ye Q, Han T, Yan J, Sun L, Wang F . Study of the sleep quality and psychological state of patients with hepatitis B liver cirrhosis. Hepatol Res. 2017; 48(3):E275-E282. DOI: 10.1111/hepr.12981. View

15.

Montagnese S, Middleton B, Skene D, Morgan M . Night-time sleep disturbance does not correlate with neuropsychiatric impairment in patients with cirrhosis. Liver Int. 2009; 29(9):1372-82. DOI: 10.1111/j.1478-3231.2009.02089.x. View

16.

Campagna F, Montagnese S, Schiff S, Biancardi A, Mapelli D, Angeli P . Cognitive impairment and electroencephalographic alterations before and after liver transplantation: what is reversible?. Liver Transpl. 2014; 20(8):977-86. DOI: 10.1002/lt.23909. View

17.

PARSONS-SMITH B, Summerskill W, Dawson A, Sherlock S . The electroencephalograph in liver disease. Lancet. 1957; 273(7001):867-71. DOI: 10.1016/s0140-6736(57)90005-3. View

18.

Stewart C, Malinchoc M, Kim W, Kamath P . Hepatic encephalopathy as a predictor of survival in patients with end-stage liver disease. Liver Transpl. 2007; 13(10):1366-71. DOI: 10.1002/lt.21129. View

19.

Amodio P, Biancardi A, Montagnese S, Angeli P, Iannizzi P, Cillo U . Neurological complications after orthotopic liver transplantation. Dig Liver Dis. 2007; 39(8):740-7. DOI: 10.1016/j.dld.2007.05.004. View

20.

Ichikawa T, Naota T, Miyaaki H, Miuma S, Isomoto H, Takeshima F . Effect of an oral branched chain amino acid-enriched snack in cirrhotic patients with sleep disturbance. Hepatol Res. 2010; 40(10):971-8. DOI: 10.1111/j.1872-034X.2010.00701.x. View