On the Origin and the Consequences of Circadian Abnormalities in Patients With Cirrhosis

Sleep and Circadian Rhythms in Hospitalized Patients with Decompensated Cirrhosis: Effect of Light Therapy

“…These findings could relate to both decompensation of cirrhosis, as previously suggested [40], and also to the hospital environment, in which patients are often disturbed across the 24-hours in relation to drug and food delivery, and management of other patients who are in nearby rooms. In addition, there is a possibility that an abnormally late melatonin/aMT6s peak, which can be detected in decompensated patients with cirrhosis in very tightly controlled light conditions [5,6] might have been suppressed by morning light, thus completely masking the underlying rhythm. Furthermore, kidney failure may have impinged on urinary aMT6s excretion, although the profiles of the two patients with hepato-renal syndrome did not seem different from the remaining five.…”

“…While limited data are available onthe homeostatic regulation in patients with cirrhosis, their circadian timing system has been studied in some depth. These patients exhibit delayed melatonin rhythms, in association with delayed sleep habits, which are probably due to a combination of impaired sensitivity to light and delayed hepatic melatonin metabolism [5][6][7]. This type of circadian disturbance is not unlike jet-lag East, or delayed sleep phase syndrome (DSPS), a condition characterized by sleep onset and wake times that are considerably delayed relative to conventional sleep-wake times [8].…”

The Effects of Poor Sleep Quality on Cognitive Function of Patients with Cirrhosis

“…10 Among patients with cirrhosis, defi cits in sleep and cognition can have serious negative effects on their quality of life, safe driving, and workplace productivity. 1,[13][14][15] In previous work, actigraphy and a validated sleep questionnaire were used to evaluate sleep disturbances in patients with cirrhosis compared to a healthy volunteer group. 1 The cirrhosis group was found to have greater diffi culties initiating sleep, signifi cantly shorter total sleep time, more frequent awakenings, more diffi culty awakening in the morning, and higher levels of daytime sleepiness.…”

“…1,[13][14][15] In previous work, actigraphy and a validated sleep questionnaire were used to evaluate sleep disturbances in patients with cirrhosis compared to a healthy volunteer group. 1 The cirrhosis group was found to have greater diffi culties initiating sleep, signifi cantly shorter total sleep time, more frequent awakenings, more diffi culty awakening in the morning, and higher levels of daytime sleepiness. Underlying these fi ndings was a circadian delay, as evidenced by the plasma melatonin peak in patients with cirrhosis and a healthy group.…”

“…An infl ammatory bowel disease (IBD) control group (n = 23) was similarly recruited and evaluated to control for the secondary effect of a chronic illness on cognition. PSQI global and component scores were used to predict cognitive function in each neurocognitive domain, using linear regression Results: Global PSQI scores were signifi cantly higher (indicating poorer sleep quality) in the cirrhosis group (median [range] = 10 [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]) than in IBD controls = 5 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14); p = 0.002). After controlling for age and education, short duration of sleep was associated with impaired memory for patients with cirrhosis; the use of soporifi c agents was associated with poor visual-perceptual function in patients with IBD.…”