Glucose fluctuations reduce quality of sleep and of life in patients with liver cirrhosis.

Abstract

Sleep disturbance and decreased health-related quality of life (HRQOL) are significant complaints in patients with liver cirrhosis. Although the etiology of these complications is unclear, we propose that glucose intolerance may be a predisposing factor. Therefore, our aim was to investigate the relationship between glucose intolerance and these complications. We assessed continuous glucose monitoring in 43 patients with chronic liver disease. Among these patients, 36 completed the Pittsburgh Sleep Quality Index (PSQI), the 36-Item Short-form Health Survey (SF-36), and the Neuropsychological Test (NPT). We also assessed the change in glucose fluctuations between preoperative periods and 1year after liver transplantation in 13 patients. Standard deviation (SD) of blood glucose was 24.15±13.52. SD values correlated to glucose metabolism measures, including HbA1c and glycoalbumin. SD values also correlated to markers of liver fibrosis, including type IV collagen. Twenty-one patients (58.3%) were classified as "poor" sleepers, with a global PSQI score ≥6. Glucose fluctuations correlated with the global PSQI score (r=0.456, p=0.008) and the SF-36 score (r=0.434, p=0.013). Multivariate regression analysis identified SD values as an independent risk factor for sleep disturbance (r=0.12, p=0.039) and decreased HRQOL (r=-0.32, p=0.024). SD values did not correlate with the NPT. SD values were also improved in 11 (84.6%) patients 1year after liver transplantation. Abnormal glucose fluctuations are a risk factor for sleep disturbance and decrease of HRQOL in patients with cirrhosis.