Abstract
Patients with Primary Biliary Cholangitis (PBC) exhibit delayed sleep-wake habits, disturbed night sleep and daytime sleepiness/fatigue. Such combination of symptoms is reminiscent of delayed sleep-wake phase disorder (DSPD), which benefits from morning light treatment. The aim of the present pilot study was to test the effect of morning light treatment in a group of 13 well-characterized patients with PBC [all females; (mean ± SD) 53 ± 10 years]. Six healthy individuals (4 females, 57 ± 14 years) and 7 patients with cirrhosis (1 female, 57 ± 12 years) served as controls and diseased controls, respectively. At baseline, all participants underwent an assessment of quality of life, diurnal preference, sleep quality/timing (subjective plus actigraphy), daytime sleepiness, and urinary 6-sulphatoxymelatonin (aMT6s) rhythmicity. Then they underwent a 15-day course of morning bright light treatment, immediately after getting up (light box, 10,000 lux, 45 min) whilst monitoring sleep-wake patterns and aMT6s rhythmicity. At baseline, both patients with PBC and patients with cirrhosis had significantly worse subjective sleep quality compared to controls. In patients with PBC, light treatment resulted in an improvement in subjective sleep quality and a reduction in daytime sleepiness. In addition, both their sleep onset and get-up time were significantly advanced. Finally, the robustness of aMT6s rhythmicity (i.e., strength of the cosinor fit) increased after light administration but post-hoc comparisons were not significant in any of the groups. In conclusion, a brief course of morning bright light treatment had positive effects on subjective sleep quality, daytime sleepiness, and sleep timing in patients with PBC. This unobtrusive, side-effect free, non-pharmacological treatment is worthy of further study.
Highlights
We confirmed that non-cirrhotic patients with Primary biliary cholangitis (PBC) and patients with cirrhosis of etiology other than PBC exhibit impaired sleep quality compared to healthy volunteers
Light exposure resulted in improved subjective night sleep quality, reduced daytime sleepiness and earlier sleep onset and get-up times
More robust assessment of urinary 6-sulphatoxymelatonin (aMT6s) rhythmicity was observed in PBC and cirrhotic patients after light treatment
Summary
Primary biliary cholangitis (PBC) is a rare, immune-mediated cholestatic liver disease (Selmi et al, 2011; Hirschfield and Gershwin, 2013; Beuers et al, 2015; Webb and Hirschfield, 2017), mostly affecting women, with the following features: cholestasis, serologic reactivity to antimitochondrial antibodies (AMA) or specific antinuclear antibody (ANA) reactivity, and histological evidence of Chronotherapy in Primary Biliary Cholangitis chronic non-suppurative, granulomatous, lymphocytic small bile duct cholangitis. An interplay between their sleep-wake timing and the daytime course of symptoms such as pruritus and sleepiness has been documented (Montagnese et al, 2013). A complex set of interacting and possibly conflicting factors simultaneously impinge on these patients’ sleep and wake quality, and daytime symptoms such as sleepiness and fatigue (McDonald et al, 2010)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
