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CC BY-NC-ND 4.0 · Sleep Sci 2021; 14(03): 266-272
DOI: 10.5935/1984-0063.20200060
SHORT COMMUNICATIONS

Prevalence and correlates of poor sleep quality in chronic liver disease patients

Authors

  • Akash Kumar

    1   All India Institute of Medical Sciences, Psychiatry - Dehradun - Uttarakhand - India.

  • Ravi Gupta

    1   All India Institute of Medical Sciences, Psychiatry - Dehradun - Uttarakhand - India.

  • Rohit Gupta

    2   All India Institute of Medical Sciences, Gastroenterology - Dehradun - Uttrakhand - India.
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ABSTRACT

Introduction: Previously done studies have shown that 39.6%-81% of subjects with chronic liver disease (CLD) report poor sleep quality and 42% experience insomnia. However, despite the high prevalence of insomnia and poor sleep quality in this group of patients, literature is scanty. In addition, previous studies have not ruled out subjects with restless legs syndrome, which is seen in a sizable number of subjects having CLD.

Material and Methods: Adult patients with a clinical diagnosis of CLD were included after excluding potential confounders. The etiology of CLD was investigated. The severity of liver disease was assessed and graded as Child-Turcotte-Pugh (CTP) class A, B or C; model for end-stage liver disease (MELD) score and as the presence of compensated or decompensated liver disease. Acute on chronic liver failure was also defined as per APASL criteria. For the present study, subjects having a score greater than 14 on insomnia severity index along with clinical diagnosis (DSM-5) were considered as having insomnia. Depression was diagnosed using a patient health questionnaire (PHQ-9) along with clinical criteria following DSM-5. Sleep quality was assessed by the Pittsburg sleep quality index - Hindi version. RLS was diagnosed on clinical interview and examination. The severity of RLS was assessed using international RLS severity rating scales.

Results: This cross-sectional study included 131 subjects. This sample had a predominance of males (78.6%), the average age of subjects was 48.70+12.31 years and 98.5% of subjects had decompensated liver disease. 54.2% had a history of alcohol use disorder and 45% had a history of nicotine use disorder. The prevalence of hepatitis B and C infection was 16.8% and 23.7%, respectively. Acute on chronic liver failure was observed in 22.9% of subjects. 19.8% of subjects had acute kidney injury. Poor sleep quality was reported by 37.4% of subjects in this study which was higher than population prevalence (p<0.001). Subjects with poor sleep quality had a higher proportion of insomnia, RLS, and depression. 19.8% of subjects reported insomnia in the present study and depressive symptoms were more severe among subjects with insomnia. RLS was reported by 19.1% of subjects and 2.3% had a positive family history of RLS. However, there was no difference in sleep quality and insomnia in patients with or without RLS.

Conclusion: The present study shows that insomnia and poor sleep quality are more prevalent among patients with CLD. Sleep disturbance is associated with depressive symptoms and can worsen the quality of life.

Keywords:

Sleep - Depression - Restless Legs Syndrome


Publication History

Received: 24 April 2020

Accepted: 12 September 2020

Article published online:
30 November 2023

© 2021. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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