Abstract

The causal association between sarcopenia and sleep disorders in patients with chronic liver diseases (CLDs) is unclear. The present study aimed to examine the influence of sarcopenia‑related factors [grip strength (GS) and muscle mass] on the progression of sleep disorders in patients with CLD (n=182, 46 cirrhotic cases; median age, 64 years). Sleep quality was evaluated by the Japanese version of Pittsburgh Sleep Quality Index (PSQI‑J). A PSQI‑J score >5 points was defined as a sleep disorder. In all analyzed patients, evaluation using the PSQI‑J questionnaire was performed >2 times during the observation period. The time interval from the date of baseline PSQI‑J and the first confirmed date of the elevation of PSQI‑J score was calculated. The primary endpoint was the elevation of the PSQI‑J score compared to the baseline PSQI‑J score. The decline in GS was diagnosed with a GS of <26 kg for males and <18 kg for females. The loss of muscle mass was diagnosed by a skeletal muscle index (SMI) of <7.0 kg/m2 for males and <5.7 kg/m2 for females on bioelectrical impedance analysis. The median PSQI‑J score was 5. A PSQI‑J score of >5 points at baseline was found in 83 patients (45.6%). In patients with a decline in GS (n=48), the 3‑year cumulative elevation rate of the PSQI‑J score was 82.4%, while in patients with no decline in GS, it was 36.2% (P<0.0001). In patients with a decline in SMI (n=64), the 3‑year cumulative elevation rate of the PSQI‑J score was 60.6%, while in patients with no decline in SMI, it was 43.4% (P=0.1822). On the multivariate analysis of factors associated with the elevation of the PSQI‑J score, only the decline in GS (P=0.0002) was a significant factor. On the whole, the present study demonstrates that a reduced GS rather than the loss of muscle mass is independently associated with an elevated risk for the progression of sleep disorders in patients with CLD.

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