Brief Article
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World J Gastroenterol. Jun 14, 2013; 19(22): 3433-3438
Published online Jun 14, 2013. doi: 10.3748/wjg.v19.i22.3433
Polysomnographic sleep aspects in liver cirrhosis: A case control study
Vinicius Vasconcelos Teodoro, Mauricio Augusto Bragagnolo Júnior, Ligia Mendonça Lucchesi, Daniel Cavignolli, Marco Túlio de Mello, Mario Kondo, Sergio Tufik
Vinicius Vasconcelos Teodoro, Ligia Mendonça Lucchesi, Daniel Cavignolli, Marco Túlio de Mello, Sergio Tufik, Department of Psychobiology, Federal University of São Paulo, São Paulo 04024-002, Brazil
Mauricio Augusto Bragagnolo Júnior, Mario Kondo, Department of Gastroenterology, Federal University of São Paulo, São Paulo 04024-002, Brazil
Author contributions: de Mello MT, Kondo M and Tufik S designed the study and interpreted the results; Teodoro VV, Júnior MAB and Cavignoli D performed the research; Teodoro VV, Júnior MAB, Lucchesi LM analyzed the data and wrote the paper.
Supported by Grants from the Associação Fundo de Incentivo a Pesquisa and FAPESP-CEPID-Proc. 95/14303-3
Correspondence to: Ligia Mendonça Lucchesi, MD, PhD, Department of Psychobiology, Federal University of São Paulo, Rua Napoleão de Barros 925, São Paulo 04024-002, Brazil.
Telephone: +55-11-21490155 Fax: +55-11-55725092
Received: September 19, 2012
Revised: January 22, 2013
Accepted: February 5, 2013
Published online: June 14, 2013

AIM: To study sleep aspects and parameters in cirrhotic patients and assess the role of liver dysfunction severity in polysomnographic results.

METHODS: This was a case-control study. Patients with a diagnosis of liver cirrhosis were consecutively enrolled in the study. Clinical examinations and laboratory liver tests were performed in all patients, and disease severity was assessed using the Child-Pugh score. The control group consisted of age- and gender-matched healthy volunteers. All individuals answered a questionnaire about habits, behaviors, and complaints related to sleep and were submitted to polysomnography. Sleep parameters were compared between the two groups, and separate analyses were performed among classes of Child-Pugh classification in the cirrhotic group.

RESULTS: Forty-two cirrhotic patients and forty-two controls were enrolled. Compared to the control group, the cirrhotic group exhibited lower sleep efficiency (mean ± SD: 73.89% ± 14.99% vs 84.43% ± 8.55%, P < 0.01), increased latency (151.27 ± 93.24 min vs 90.62 ± 54.74 min, P < 0.01) and a lower percentage of rapid eye movement (REM) sleep (14.04% ± 5.64% vs 20.71% ± 6.77%, P < 0.05) as well as a higher frequency of periodic limb movements (10.56 ± 2.85/h vs 2.79 ± 0.61/h, P < 0.01). The comparison of sleep parameters among Child A, B and C cirrhotic patients revealed a significant reduction of REM sleep stage occurrence in individuals with severe liver disease (Child C patients) compared to Child A/B patients (polysomnography percentage of REM sleep stage of patients Child A: 16.1% ± 1.2%; Child B: 14.9% ± 1.2%; Child C: 8.6% ± 1.6%, P < 0.05).

CONCLUSION: Cirrhosis was associated with shorter sleep time, reduced sleep efficiency, increased sleep latency, increased REM latency and reduced REM sleep. Additionally, disease severity influences sleep parameters.

Keywords: Liver cirrhosis, Sleep, Child-Pugh classification, Polysomnography, Rapid eye movement sleep, Periodic limb movements in sleep, Apnea-hypopnea index, Obstructive sleep apnea syndrome