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http://crossmark.crossref.org/dialog/?doi=10.1007/s11011-016-9944-5&domain=pdf
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Web End = Metab Brain Dis (2017) 32:595605 DOI 10.1007/s11011-016-9944-5
ORIGINAL ARTICLE
Sleep disturbances in patients of liver cirrhosis with minimal hepatic encephalopathy before and after lactulose therapy
Jatinderpal Singh1 & Barjesh Chander Sharma1 & Vinod Puri2 &
Sanjeev Sachdeva1 & Siddharth Srivastava1
Received: 28 June 2016 /Accepted: 26 December 2016 /Published online: 9 January 2017 # Springer Science+Business Media New York 2017
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, age45.3 11.2 years, 45 males) no-MHE (n = 50, age46.3 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 mol/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.
Keywords Hepatic encephalopathy . Lactulose
CTRI Registration number: CTRI/2015/01/005464, http://www.ctri.nic.in
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Electronic supplementary material The online version of this article (doi:http://dx.doi.org/10.1007/s11011-016-9944-5
Web End =10.1007/s11011-016-9944- 5) contains supplementary material, which is available to authorized users.
* Barjesh Chander Sharma [email protected]
Jatinderpal Singh [email protected]