![]() Almost 50% of patients with cirrhosis without HE reported unsatisfactory sleep. PSQI was higher in those patients with evidence of hepatic encephalopathy (HE) and those with increased PSQI suffered from worse health-related quality of life ( 1, 4). ![]() Sleep disturbance is relatively common in patients with CLD and cirrhosis 60–80% of patients with cirrhosis rated themselves as poor sleepers, according to the Pittsburgh Sleep Quality Index (PSQI). There were no restrictions on dates or study design. Literature for this narrative review was identified using the following terms in Medline and Embase: liver, chronic, sleep, excessive daytime sleepiness, non-alcoholic fatty liver disease, cirrhosis, obstructive sleep apnoea, respiratory and pulmonary. We present the following article in accordance with the Narrative Review Checklist (available at ). Many clinical and research questions remain unanswered in this field and this review highlights potential future avenues for investigation. While it is recognised that neurology has an important contribution, it is beyond the scope of this review to discuss this. ![]() This review will focus on the respiratory contribution to the development of sleep disturbance in CLD. Finally, liver dysfunction in obstructive sleep apnoea (OSA), and particularly the association with non-alcoholic fatty liver disease (NAFLD), will be explored. The limited management options currently available for sleep disturbance in CLD will then be described. This review will discuss the prevalence and character of sleep disturbance in CLD and then describe possible pathophysiological mechanisms causing sleep disturbance within this population. In addition, patients with sleep disorders may be at increased risk of developing liver malignancy ( 3) it is therefore an important area to review. Sleep disturbance in patients with cirrhosis is independently associated with reduced health-related quality of life ( 1, 2). The association between sleep disturbance and chronic liver disease (CLD) is increasingly recognized as an important part of the disease course of patients with CLD. Keywords: Chronic liver disease cirrhosis non-alcoholic fatty liver disease sleep disturbance obstructive sleep apnoea There remain many outstanding areas of investigation in the management of sleep disturbance in CLD, and of liver dysfunction in OSA. Treatment of the intermittent hypoxia with continuous positive airway pressure therapy has limited efficacy against liver dysfunction. The presence of reactive oxygen species and the overexpression of hypoxia inducible factor 1-alpha secondary to hypoxia may be responsible for the second ‘hit’ of the ‘two-hit’ hypothesis of NAFLD. This chronic intermittent hypoxia appears to contribute to the development of NAFLD. Obstructive sleep apnoea (OSA) is a common condition that causes chronic intermittent hypoxia due to airway collapse during sleep. ![]() There are currently limited management options for sleep disturbance in CLD. Specific conditions causing CLD, such as non-alcoholic fatty liver disease (NAFLD), chronic viral hepatitis and primary biliary cholangitis (PBC) result in different types of sleep disturbance, and the treatment of these conditions can often also lead to sleep disturbance. Key contributors to sleep disturbance include hepatic encephalopathy (HE) and circadian rhythm imbalance due to altered melatonin metabolism. Interviews with Outstanding Guest EditorsĪbstract: Sleep disturbance is a common feature of chronic liver disease (CLD) with impact on health-related quality of life 60–80% of patients with CLD report subjective poor sleep frequent presentations of sleep disturbance include insomnia, reduced sleep efficiency, increased sleep latency, reduced time in rapid eye movement (REM) sleep, restless leg syndrome and excessive daytime sleepiness (EDS).Policy of Dealing with Allegations of Research Misconduct.Policy of Screening for Plagiarism Process.
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