Abstract

Goals We aimed to examine patients with liver cirrhosis and compare their sleep characteristics with those of healthy controls using innovative new electroencephalogram models.

Background Sleep disturbance is a common disorder in patients with cirrhosis. Many previous studies have been conducted on the topic using questionnaire methods. However, polysomnographic quantitative assessments remain challenging because they are complicated and difficult to implement at the clinical research level.

Study We recruited patients with early liver disease with a low probability of causing sleep disturbances, body mass index (BMI) ≤31 kg/m2, history of alcohol use, itching, and no severe encephalopathy. Using propensity score matching among 20 patients with liver cirrhosis and 95 healthy older adults, the sleep structure of 18 patients with cirrhosis was analyzed and compared with that of 18 healthy adults matched for age, sex, and BMI. Sleep structure in both the groups was assessed using data obtained from a portable electroencephalogram (EEG) device, including total sleep time, sleep latency, wakefulness after sleep onset, sleep efficiency, sleep stages, and rapid eye movement (REM) latency. Sleep stages included REM and non-rapid eye movement (non-REM) stages (stages N1, N2, and N3). Self-report questionnaires were administered to the participants to confirm subjective and objective sleep statuses.

Results Questionnaire responses revealed that neither group reported any severe sleep disturbances. Regarding sleep structure assessment using a portable EEG device, patients with cirrhosis exhibited longer sleep latency, suboptimal wakefulness after sleep onset, and poorer sleep efficiency than healthy controls. In patients with cirrhosis, the total time and percentage of N1 sleep were longer; total time and percentage of REM sleep were shorter; and REM latency was prolonged.

Conclusions A high frequency of severely unrecognized sleep disturbances was observed in patients with cirrhosis using home portable polysomnography.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

grant-in-aid for scientific research (grant number: 20K08326) from the Ministry of Education, Culture, Sports, Science, and Technology (given to Hiroteru Kamimura).

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study protocol conformed to the guidelines of the Declaration of Helsinki (as revised in Fortaleza, Brazil, October 2013) and was approved by the institutional Ethics Review Board of the Niigata University (approval number: 2021-0274). Additionally, we used the data from the study by Seol et al. (2022) [4] approved by the Ethics Committee of the University of Tsukuba (approval number: R02-211).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

All data produced in the present study are available upon reasonable request to the authors

AbbreviationsAASMAmerican Academy of Sleep MedicineEEGElectroencephalogramESSEpworth Sleepiness ScaleHEHepatic encephalopathynon-REMnon-rapid eye movementREMrapid eye movement