Prevalence and clinical correlates of insomnia symptoms and their association with quality of life in Chinese patients with HBV-related liver disease.

Jing Zhao,Ines Hang Iao Chow,Chee H Ng,Yu Chen,Yu-Tao Xiang,Su-Jun Zheng,Gabor S Ungvari,Zhongping Duan,Ting Wang,Mei Liu

doi:10.7717/peerj.10956

Abstract

ObjectiveThis study aimed to describe the one-month prevalence of insomnia symptoms (insomnia hereafter) and the demographic and clinical correlates, and its association with quality of life (QOL) in Chinese patients with HBV-related liver disease.MethodA total of 689 patients with HBV-related liver disease in Beijing, China formed the study sample. Three forms of insomnia including difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS) and early morning awakening (EMA) were assessed using standardized questions. QOL was measured using the Medical Outcomes Study Short Form 12 (SF-12).ResultsThe one-month prevalence of at least one type of insomnia was 69.5%, while DIS, DMS and EMA were 60.4%, 54.7% and 50.9%, respectively. Only 4.8% of patients suffering from insomnia received treatment. Multiple logistic regression analyses revealed that pre-existing medical conditions were positively associated with DIS and EMA; patients with more severe depressive symptoms were more likely to have DIS, DMS and EMA; local residents were less likely to have DIS; and those who were married and older were more likely to have DMS. Insomnia was not independently associated with QOL.ConclusionsInsomnia is common in Chinese patients with HBV-related liver disease with a very low rate of treatment. Greater attention should be given to identify and treat insomnia in this patient population.

Highlights

Hepatitis B virus (HBV) infection is a common infectious disease with around 350–400 million HBV carriers worldwide (Custer et al, 2004)
Inpatients and outpatients were consecutively recruited if they were (1) aged 18 years or above; (2) diagnosed as HBV carrier, chronic hepatitis B (CHB), hepatitis B cirrhosis or HCC according to the Guidelines of Prevention and Treatment for Chronic Hepatitis B (2010 version) (Jia & Li, 2011) and the Recommendations of the Asian Pacific Association for the Study of the Liver (APASL) for the management of hepatocellular carcinoma (Sarin et al, 2009); (3) Chinese descent; (4) able to communicate adequately, tolerate a one-hour interview and comprehend the purpose of the study
Socio-demographic data such as age, gender, education, residence, marital status, personal monthly income, public health insurance were collected using a form designed for this study. Clinical data such as family history of psychiatric disorders, current use of alcohol, diagnoses of HBV-related liver disease, pre-existing medical conditions, age of onset of HBV, duration of HBV-related liver disease, number of hospitalizations were collected from a review of the medical records

Summary

Introduction

Hepatitis B virus (HBV) infection is a common infectious disease with around 350–400 million HBV carriers worldwide (Custer et al, 2004). In China, there are approximately 93 million HBV carriers and among them, 30 million suffer from chronic hepatitis B (Liang et al, 2009). It is estimated that the annual direct and indirect health cost for a patient suffering from compensated or decompensated liver cirrhosis is USD 5,100 and USD 5,200, respectively in China (Lu & Zhuang, 2009). In a study involving 40 patients each with HBV-related acute-on-chronic liver failure (ACLF), HBV-related cirrhosis or chronic hepatitis B (CHB), patients with ACLF and cirrhosis reported more severe depressive symptoms with the mean Hamilton Rating Scale for Depression (HAMD) total score of 11.58 (SD=9.48) and 10.60 (SD=7.51), compared to CHB patients and healthy control with the mean HAMD total score of 6.03 (SD=6.91) and 5.30 (SD=5.51), respectively (Duan et al, 2012)

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Conclusion