medigraphic.com
Órgano Oficial de la Asociación Mexicana de Hepatología

2017, Number 4

<< Back Next >>

Ann Hepatol 2017; 16 (4)

Symptoms of Daytime Sleepiness and Sleep Apnea in Liver Cirrhosis Patients

Abdullah AE, AL-Jahdali F, Ahmed AE, Shirbini N, Abdullah AL-Harbi, Salim B, Ali YZ, Abdulrahman A, Khan M, Khaleid A, Hamdan AL-Jahdali

Language: English
References: 61
Page: 591-598
PDF size: 159.08 Kb.


ABSTRACT

Background/propose. Sleep disturbance and excessive daytime sleepiness (EDS) have been reported in patients with hepatic cirrhosis with no hepatic encephalopathy (HE). The objective of this study was to evaluate daytime sleepiness and risk of obstructive sleep apnea (OSA) among liver cirrhosis patients. Material and methods. A cross-sectional study was conducted at King Abdulaziz Medical City (KAMC)-Riyadh over a period of six months, using a structured questionnaire that investigated: 1) Sleep patterns and daytime sleepiness using the Epworth Sleeping Scale (ESS), and 2) The risk for sleep apnea using the Berlin Questionnaire (BQ). We enrolled patients with a confirmed diagnosis of liver cirrhosis who were being followed at the hepatology and pre-liver transplant clinics. Results. We enrolled 200 patients with liver cirrhosis, 57.5% of whom were male. The mean age was 60 (± SD 12.2). The reported prevalence of EDS, OSA, and both EDS and OSA were 29.5%, 42.9%, and 13.6%, respectively. The prevalence of EDS was higher in patients with Hepatitis-C and patients with DM, who experienced short sleep duration. We did not find any association between the severity of liver disease and EDS or OSA as measured by Child-Pugh scores (CPS). Conclusions. The risk of OSA and EDS is high among liver cirrhosis patients. Those patients with cirrhosis secondary to Hepatitis C are at higher risk of EDS and OSA. Both EDS and OSA affect patients designated as CPS Class A more frequently than patients designated as CPS Class B.


REFERENCES

  1. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middleaged adults. N Engl J Med 1993; 328: 1230-5.

  2. Lindberg E, Gislason T. Epidemiology of sleep-related obstructive breathing. Sleep Med Rev 2000; 4: 411-33.

  3. Resta O, Foschino-Barbaro MP, Legari G, Talamo S, Bonfitto P, Palumbo A, Minenna A, et al. Sleep-related breathing disorders, loud snoring and excessive daytime sleepiness in obese subjects. Int J Obes Relat Metab Disord 2001; 25: 669-75.

  4. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 2002; 165: 1217-39.

  5. Hiestand DM, Britz P, Goldman M, Phillips B. Prevalence of symptoms and risk of sleep apnea in the US population: Results from the national sleep foundation sleep in America 2005 poll. Chest 2006; 130: 780-6.

  6. Simon S, Collop N. Latest advances in sleep medicine: obstructive sleep apnea. Chest 2012; 142: 1645-51.

  7. Sundaram SS, Sokol RJ, Capocelli KE, Pan Z, Sullivan JS, Robbins K, Halbower AC. Obstructive sleep apnea and hypoxemia are associated with advanced liver histology in pediatric nonalcoholic fatty liver disease. J Pediatr 2014; 164: 699-706 e1.

  8. Mishra P, Nugent C, Afendy A, Bai C, Bhatia P, Afendy M, Fang Y, et al. Apnoeic-hypopnoeic episodes during obstructive sleep apnoea are associated with histological nonalcoholic steatohepatitis. Liver Int 2008; 28: 1080-6.

  9. Tanne F, Gagnadoux F, Chazouilleres O, Fleury B, Wendum D, Lasnier E, Lebeau B, et al. Chronic liver injury during obstructive sleep apnea. Hepatology 2005; 41: 1290-6

  10. Tian JL, Zhang Y, Chen BY. Sleep apnea hypopnea syndrome and liver injury. Chin Med J (Engl) 2010; 123: 89-94.

  11. Turkay C, Ozol D, Kasapoglu B, Kirbas I, Yildirim Z, Yigitoglu R. Influence of obstructive sleep apnea on fatty liver disease: role of chronic intermittent hypoxia. Respir Care 2012; 57: 244-9.

  12. Byrne TJ, Parish JM, Somers V, Aqel BA, Rakela J. Evidence for liver injury in the setting of obstructive sleep apnea. Ann Hepatol 2012; 11: 228-31.

  13. Petta S, Marrone O, Torres D, Buttacavoli M, Camma C, Di Marco V, Licata A, et al. Obstructive Sleep Apnea Is Associated with Liver Damage and Atherosclerosis in Patients with Non-Alcoholic Fatty Liver Disease. PLoS One 2015; 10: e0142210.

  14. Montagnese S, Middleton B, Mani AR, Skene DJ, Morgan MY. On the origin and the consequences of circadian abnormali ties in patients with cirrhosis. Am J Gastroenterol 2010; 105: 1773-81.

  15. Tarter RE, Hegedus AM, Van Thiel DH, Schade RR, Gavaler JS, Starzl TE. Nonalcoholic cirrhosis associated with neuropsychological dysfunction in the absence of overt evidence of hepatic encephalopathy. Gastroenterology 1984; 86: 1421-7.

  16. Crespo J, Cifrian J, Pinto JA, Jimenez-Gomez A, Pons-Romero F. Sleep apnea obstructive syndrome: a new complication previously undescribed in cirrhotic patients with ascites. Am J Gastroenterol 2003; 98: 2815-6.

  17. Nikaina I, Pastaka C, Zachou K, Dalekos GN, Gourgoulianis K. Sleep apnoea syndrome and early stage cirrhosis: a pilot study. Eur J Gastroenterol Hepatol 2006; 18: 31-5.

  18. Javaheri S, Almoosa KF, Saleh K, Mendenhall CL. Hypocapnia is not a predictor of central sleep apnea in patients with cirrhosis. Am J Respir Crit Care Med 2005; 171: 908-11.

  19. Lozeva-Thomas V. Serotonin brain circuits with a focus on hepatic encephalopathy. Metab Brain Dis 2004; 19: 413-20.

  20. Ahabrach H, Piedrafita B, Ayad A, El Mlili N, Errami M, Felipo V, Llansola M. Chronic hyperammonemia alters the circadian rhythms of corticosteroid hormone levels and of motor activity in rats. J Neurosci Res 2010; 88: 1605-14.

  21. Montagnese S, Middleton B, Mani AR, Skene DJ, Morgan MY. Sleep and circadian abnormalities in patients with cirrhosis: features of delayed sleep phase syndrome? Metab Brain Dis 2009; 24: 427-39.

  22. Marchesini G, Bianchi G, Amodio P, Salerno F, Merli M, Panella C, Loguercio C, et al., Italian Study Group for quality of life in c. Factors associated with poor health-related quality of life of patients with cirrhosis. Gastroenterology 2001; 120: 170-8.

  23. Bajaj JS, Thacker LR, Leszczyszyn D, Taylor SA, Heuman DM, Raman S, Sterling RK, et al. Effects of obstructive sleep apnea on sleep quality, cognition, and driving performance in patients with cirrhosis. Clin Gastroenterol Hepatol 2015; 13: 390-7 e1.

  24. Newton JL, Jones DE, Henderson E, Kane L, Wilton K, Burt AD, Day CP. Fatigue in non-alcoholic fatty liver disease (NAFLD) is significant and associates with inactivity and excessive daytime sleepiness but not with liver disease severity or insulin resistance. Gut 2008; 57: 807-13.

  25. Kallwitz ER, Herdegen J, Madura J, Jakate S, Cotler SJ. Liver enzymes and histology in obese patients with obstructive sleep apnea. J Clin Gastroenterol 2007; 41: 918-21.

  26. Polotsky VY, Patil SP, Savransky V, Laffan A, Fonti S, Frame LA, Steele KE, et al. Obstructive sleep apnea, insulin resistance, and steatohepatitis in severe obesity. Am J Respir Crit Care Med 2009; 179: 228-34.

  27. Daltro C, Cotrim HP, Alves E, de Freitas LA, Araujo L, Boente L, Leal R, et al. Nonalcoholic fatty liver disease associated with obstructive sleep apnea: just a coincidence? Obes Surg 2010; 20: 1536-43.

  28. Aron-Wisnewsky J, Minville C, Tordjman J, Levy P, Bouillot JL, Basdevant A, Bedossa P, et al. Chronic intermittent hypoxia is a major trigger for non-alcoholic fatty liver disease in morbid obese. J Hepatol 2012; 56: 225-33.

  29. Verhulst SL, Jacobs S, Aerts L, Schrauwen N, Haentjens D, Rooman RP, Gaal LV, et al. Sleep-disordered breathing: a new risk factor of suspected fatty liver disease in overweight children and adolescents? Sleep Breath 2009; 13: 207-10.

  30. Drager LF, Polotsky VY, Lorenzi-Filho G. Obstructive sleep apnea: an emerging risk factor for atherosclerosis. Chest 2011; 140: 534-42.

  31. Young T, Finn L, Peppard PE, Szklo-Coxe M, Austin D, Nieto FJ, Stubbs R, et al. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep 2008; 31: 1071-8.

  32. Coughlin SR, Mawdsley L, Mugarza JA, Calverley PM, Wilding JP. Obstructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome. Eur Heart J 2004; 25: 735-41.

  33. Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoeahypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005; 365: 1046-53.

  34. Shpirer I, Copel L, Broide E, Elizur A. Continuous positive airway pressure improves sleep apnea associated fatty liver. Lung 2010; 188: 301-7.

  35. Buttacavoli M, Gruttad'Auria CI, Olivo M, Virdone R, Castrogiovanni A, Mazzuca E, Marotta AM, et al. Liver Steatosis and Fibrosis in OSA patients After Long-term CPAP Treatment: A Preliminary Ultrasound Study. Ultrasound Med Biol 2016; 42: 104-9.

  36. Ogata T, Nomura M, Nakaya Y, Ito S. Evaluation of episodes of sleep apnea in patients with liver cirrhosis. J Med Invest 2006; 53: 159-66.

  37. Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 1999; 131: 485-91.

  38. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991; 14: 540-5.

  39. Al-Jahdali H. Prevalence of sleep apnea and excessive day time sleepiness in patients with end-stage renal disease on dialysis. Saudi J Kidney Dis Transpl 2012; 23: 251-61.

  40. Al-Jahdali HH, Khogeer HA, Al-Qadhi WA, Baharoon S, Tamim H, Al-Hejaili FF, et al. Insomnia in chronic renal patients on dialysis in Saudi Arabia. J Circadian Rhythms 2010; 8: 7.

  41. Bahammam AS, Al-Rajeh MS, Al-Ibrahim FS, Arafah MA, Sharif MM. Prevalence of symptoms and risk of sleep apnea in middle-aged Saudi women in primary care. Saudi Med J 2009; 30: 1572-6.

  42. BaHammam AS, Alrajeh MS, Al-Jahdali HH, BinSaeed AA. Prevalence of symptoms and risk of sleep apnea in middleaged Saudi males in primary care. Saudi Med J 2008; 29: 423-6.

  43. Hind Alruwaili, Anwar Ahmed, Abdulhamid Fatani, Khalid Al- Otaibi, Sarah AL-Jahdali, Yosra Ali, Abdullah Al-Harbi, et al. Symptoms and risk for obstructive sleep apnea among sample of Saudi Arabian adults. Sleep and Biological Rhythms 2015; 13: 332-41.

  44. Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973; 60: 646-9.

  45. Saleh AB, Ahmad MA, Awadalla NJ. Development of Arabic version of Berlin questionnaire to identify obstructive sleep apnea at risk patients. Ann Thorac Med 2011; 6: 212-6.

  46. Netzer NC, Hoegel JJ, Loube D, Netzer CM, Hay B, Alvarez- Sala R, Strohl KP. Prevalence of symptoms and risk of sleep apnea in primary care. Chest 2003; 124: 1406-14.

  47. Anwar E. Ahmed AF, Abdullah Al-Harbi, Abdullah Al-Shimemeri, Yosra Z. Ali, Salim Baharoon, Hamdan Al-Jahdali. Validation of the Arabic version of the Epworth Sleepiness Scale. J Epidemiol Global Health 2014. Available from: http:// dx.doi.org/10.1016/j.jegh.2014.04.004

  48. AASM. International Classification of Sleep Disorders. Rochester, MN, American Academy of Sleep Medicine 1997.

  49. Suman A, Barnes DS, Zein NN, Levinthal GN, Connor JT, Carey WD. Predicting outcome after cardiac surgery in patients with cirrhosis: a comparison of Child-Pugh and MELD scores. Clin Gastroenterol Hepatol 2004; 2: 719-23.

  50. Bernsmeier C, Weisskopf DM, Pflueger MO, Mosimann J, Campana B, Terracciano L, Beglinger C, et al. Sleep Disruption and Daytime Sleepiness Correlating with Disease Severity and Insulin Resistance in Non-Alcoholic Fatty Liver Disease: A Comparison with Healthy Controls. PLoS One 2015; 10: e0143293.

  51. Samanta J, Dhiman RK, Khatri A, Thumburu KK, Grover S, Duseja A, Chawla Y. Correlation between degree and quality of sleep disturbance and the level of neuropsychiatric impairment in patients with liver cirrhosis. Metab Brain Dis 2013; 28: 249-59.

  52. Mostacci B, Ferlisi M, Baldi Antognini A, Sama C, Morelli C, Mondini S, Cirignotta F. Sleep disturbance and daytime sleepiness in patients with cirrhosis: a case control study. Neurol Sci 2008; 29: 237-40.

  53. Lang CA, Conrad S, Garrett L, Battistutta D, Cooksley WG, Dunne MP, Macdonald GA. Symptom prevalence and clustering of symptoms in people living with chronic hepatitis C infection. J Pain Symptom Manage 2006; 31: 335-44.

  54. Pulixi EA, Tobaldini E, Battezzati PM, D'Ingianna P, Borroni V, Fracanzani AL, Maggioni M, et al. Risk of obstructive sleep apnea with daytime sleepiness is associated with liver damage in non-morbidly obese patients with nonalcoholic fatty liver disease. PLoS One 2014; 9: e96349.

  55. Berzigotti A, Garcia-Tsao G, Bosch J, Grace ND, Burroughs AK, Morillas R, Escorsell A, et al, Portal Hypertension Collaborative G. Obesity is an independent risk factor for clinical decompensation in patients with cirrhosis. Hepatology 2011; 54: 555-61.

  56. Chung F, Abdullah HR, Liao P. STOP-Bang Questionnaire: A practical approach to screen for obstructive sleep apnea. Chest 2015.

  57. De Cruz S, Espiritu JR, Zeidler M, Wang TS. Sleep disorders in chronic liver disease. Semin Respir Crit Care Med 2012; 33: 26-35.

  58. Musso G, Olivetti C, Cassader M, Gambino R. Obstructive sleep apnea-hypopnea syndrome and nonalcoholic fatty liver disease: emerging evidence and mechanisms. Semin Liver Dis 2012; 32: 49-64.

  59. Sockalingam S, Abbey SE, Alosaimi F, Novak M. A review of sleep disturbance in hepatitis C. J Clin Gastroenterol 2010; 44: 38-45.

  60. Musso G, Cassader M, Olivetti C, Rosina F, Carbone G, Gambino R. Association of obstructive sleep apnoea with the presence and severity of non-alcoholic fatty liver disease. A systematic review and meta-analysis. Obes Rev 2013; 14: 417-31.

  61. Benotti P, Wood GC, Argyropoulos G, Pack A, Keenan BT, Gao X, Gerhard G, et al. The impact of obstructive sleep apnea on nonalcoholic fatty liver disease in patients with severe obesity. Obesity (Silver Spring) 2016.




2020     |     www.medigraphic.com