Evaluation of episodes of sleep apnea in patients with liver cirrhosis

Abstract

Obstructive sleep apnea syndrome (OSAS) has been reported to be a new complication of liver cirrhosis with ascites. This fact prompted a study of episodes of sleep apnea as a function of the severity of cirrhosis. Forty eight patients with type C liver cirrhosis were divided according to the Child-Pugh score into 3 groups: Group A (16 patients with grade A cirrhosis), Group B (16 patients with grade B cirrhosis), and Group C (16 patients with grade C cirrhosis). Portable sleep polygraphs (Fuji RC, Inc. Tokyo, Japan) were attached to the subjects, and oronasal respiration, tracheal sounds, respiratory movements of the chest, and percutaneous arterial oxygen saturation continuously were recorded. A decrease in the mean airflow to 50% or less was defined as hypopnea, and the number per hour of episodes of apnea and hypopnea per hour lasting 10 seconds or longer (AHI) was counted. A Holter ECG was also recorded, and spectral heart rate variability during sleep was analyzed by measuring low frequency power (0.04-0.15 Hz, LF power), high frequency power (0.15-0.40 Hz, HF power), the ratio of LF power to HF power (LF/HF ratio), and very low frequency power (0.008-0.04 Hz, VLF power). The difference in QT interval between the lead CM5 and the lead CM1 (QTc dispersion) was also examined. AHI was significantly higher in Group C than in Groups A and B (p<0.05). In Group C, 6 patients with 20 times or more AHI per hour, obstructive sleep apnea, in which respiratory chest movements occur but oronasal respiration decreases or disappears, was observed. Spectral analyses of heart rate variability showed a decrease in HF power without sleep apnea, but increases in HF power and VLF power were observed during sleep apnea. The QTc dispersion increased during episodes of sleep apnea. As the stage of liver cirrhosis advanced, sleep apnea appeared, and changes in autonomic nervous activities were observed. Furthermore, QTc dispersion was increased during episodes of sleep apnea, presumably increasing the risk of ventricular arrhythmia.