Abnormalities in Skin Temperature and its 24-Hour Rhythm in Patients with Cirrhosis: Sleep-Wake and General Clinical Implications

Abstract

Background and aims: Sleep preparation/onset are associated with peripheral vasodilatation and a decrease in body temperature. It is possible that the hyperdynamic syndrome exhibited by patients with cirrhosis may impinge on sleep preparation mechanisms, thus contributing to the difficulties falling asleep exhibited by these patients. The aim of this study was the assessment of skin temperature/their 24-hour rhythm in patients with cirrhosis of varying severity, in relation to sleep-wake patterns. Methods: Twelve outpatients with cirrhosis (CO), 13 inpatients with cirrhosis (CI), 11 inpatients without cirrhosis (NCI) and 10 healthy volunteers were recruited. All underwent baseline sleep-wake evaluation (sleep quality, diurnal preference, daytime sleepiness) and bleeding for inflammatory markers and morning melatonin levels. Proximal/distal skin temperature and their gradient (DPG) were recorded for 24 hours by a wireless device (iButton) and over this period subjects were asked to keep a sleep-wake diary. Results: CI slept significantly less well than all other groups. CI/CO had higher baseline proximal temperature and blunted rhythmicity compared to the other groups. CI/NCI had higher baseline distal temperature and blunted rhythmicity compared to the other groups. CI/CO had significantly lower DPG values compared to the other groups, and DPG reached near-zero values several hours later. Significant correlations were observed between temperature and sleep-wake variables (minimum proximal temperature vs. sleep latency: r = 0.50, P < 0.05) and also between temperature and inflammatory markers/melatonin [minimum proximal temperature vs. C reactive protein: r = 0.42, P < 0.05]. Conclusions: Alterations of distal/proximal skin temperature, their gradient and their time-course were observed in patients with cirrhosis. These may contribute to the sleep disturbances exhibited by these patients. The authors have none to declare.