Effect of Sarcopenia on Sleep Disturbance in Patients with Chronic Liver Diseases

Abstract

We sought to investigate the influence of sarcopenia as defined by muscle strength and skeletal muscle mass (SMM) on sleep disturbance as evaluated by the Japanese version of Pittsburgh Sleep Quality Index (PSQI-J) in chronic liver diseases (CLDs) (n = 419). Muscle strength and muscle mass were determined by grip strength (GS) and SMM using bioimpedance analysis. Patients were classified into four types: type A (n = 61); decreased GS and decreased SMM; type B (n = 45); decreased GS and non-decreased SMM; type C (n = 102); non-decreased GS and decreased SMM; and type D (n = 211); non-decreased GS and non-decreased SMM. Factors associated with PSQI-J score 6 or more were examined. PSQI-J score 0–5 (normal) was found in 253 (60.4%); 6–8 (mild) in 97 (23.2%); 9–11 (moderate) in 45 (10.7%) and 12 or more (severe) in 24 (5.7%). Univariate analysis identified three factors to be significantly associated with PSQI-J score 6 or more: presence of liver cirrhosis (LC) (P = 0.0132); our classification of type A; B; C and D (P < 0.0001) and serum albumin level (P = 0.0041). Multivariate analysis showed that type A (P = 0.0021) and type B (P = 0.0220) were significant independent factors. In conclusion, sarcopenia in CLDs appears to be closely associated with sleep disturbance mainly due to muscle strength decline.

Frailty and Sleep Disorder in Chronic Liver Diseases

“…However, to our knowledge, scarce data of the association in sleep disorder and frailty in patients with CLD are available. Patients with CLD are often suffering from long-standing disease burden, which may affect sleep quality [ 22 ]. In our data, the median sleep duration in a day was 6.5 h, which is almost identical to the average sleep duration of Japanese adults.…”

“…They included both inpatients and outpatients. Liver cirrhosis (LC) was determined as demonstrated previously [ 22 ]. Frailty was determined using the following five phenotypes: body weight (BW) loss without intention, exhaustion, muscle strength decline [grip strength (GS) < 26 kg in males and < 18 kg in females], slow walking speed (WS, < 1.0 m/s), and low physical activity (being unable to do light exercise).…”

“…Patients with CLD often describe sleep problems and the mechanisms of sleep disorders in such patients have not been fully investigated, however, they seem to be temporally linked to CLD itself [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. Sleep disorder, which involves difficulties in falling asleep, intermittent awakening during the night and shortened total sleep duration, is a burden and negatively affects the quality of life, mood changes, and possibly fatigue, and all of them can result in adverse consequences [ 19 , 20 ].…”

The Anthropometric Assessment With the Bioimpedance Method Is Associated With the Prognosis of Cirrhotic Patients

“…We assessed the nutritional status of cirrhotic patients using various methods (9)(10)(11), and a dietitian in our department took anthropometric measurements from all patients. In this study, we evaluated the nutritional status of histologically confirmed cirrhotic patients (F4 stage of the METAVIR scoring system: liver cirrhosis with pseudolobules) (12) and compared the physical data automatically provided with the BIA method to the manually obtained ones by a trained healthcare professional.…”

Significant Correlation Between Grip Strength and m2bpgi in Patients with Chronic Liver Diseases

“…In our previous investigation, we reported that GS had a strong influence especially in the physiological domains in the 36-Item Short-Form Health Survey in patients with CLDs [4]. We also demonstrated that muscle strength decline was closely associated with sleep disorder in patients with CLDs [5], while non-alcoholic fatty liver disease (NAFLD) is reported to be linked to muscular impairment in elderly adults [6,7,8]. Lee et al reported that there were linear decreases in the NAFLD index across incremental GS values [8].…”