Abstract
BackgroundStudies have shown psychological distress in patients with cirrhosis, yet no studies have evaluated the laboratory and physiologic correlates of psychological symptoms in cirrhosis. This study therefore measured both biochemistry data and heart rate variability (HRV) analyses, and aimed to identify the physiologic correlates of depression, anxiety, and poor sleep in cirrhosis.MethodsA total of 125 patients with cirrhosis and 55 healthy subjects were recruited. Each subject was assessed through routine biochemistry, 5-minutes ECG monitoring, and psychological ratings of depression, anxiety, and sleep. HRV analysis were used to evaluate autonomic functions. The relationship between depression, sleep, and physiologic correlates was assessed using a multiple regression analysis and stepwise method, controlling for age, duration of illness, and severity of cirrhosis.ResultsReduced vagal-related HRV was found in patients with severe liver cirrhosis. Severity of cirrhosis measured by the Child-Pugh score was not correlated with depression or anxiety, and only had a weak correlation with poor sleep. The psychological distress in cirrhosis such as depression, anxiety, and insomnia were correlated specifically to increased levels of aspartate aminotransferase (AST), increased ratios of low frequency to high frequency power, or reduced nonlinear properties of HRV (α1 exponent of detrended fluctuation analysis).ConclusionsIncreased serum AST and abnormal autonomic nervous activities by HRV analysis were associated with psychological distress in cirrhosis. Because AST is an important mediator of inflammatory process, further research is needed to delineate the role of inflammation in the cirrhosis comorbid with depression.
Highlights
Studies have shown psychological distress in patients with cirrhosis, yet no studies have evaluated the laboratory and physiologic correlates of psychological symptoms in cirrhosis
Despite the relationship between cirrhosis and distressed psychological states being well-documented in aforementioned studies, no study has evaluated the laboratory and physiologic correlates of depression, anxiety, or poor sleep commonly seen in patients with cirrhosis
A body of research has emerged demonstrating that reduced vagal modulation or increased sympathetic activity are associated with anxiety [7,8,9], depression [10], and insomnia [11,12,13]; the physiological and psychological stress of cirrhosis may be measured by heart rate variability (HRV), a non-invasive measure of the cardiac autonomic nervous system
Summary
Studies have shown psychological distress in patients with cirrhosis, yet no studies have evaluated the laboratory and physiologic correlates of psychological symptoms in cirrhosis. Despite the relationship between cirrhosis and distressed psychological states being well-documented in aforementioned studies, no study has evaluated the laboratory and physiologic correlates of depression, anxiety, or poor sleep commonly seen in patients with cirrhosis. These psychological manifestations are known risk factors for cardiovascular morbidity and are associated with autonomic dysregulation. A body of research has emerged demonstrating that reduced vagal modulation or increased sympathetic activity are associated with anxiety [7,8,9], depression [10], and insomnia [11,12,13]; the physiological and psychological stress of cirrhosis may be measured by heart rate variability (HRV), a non-invasive measure of the cardiac autonomic nervous system
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