Prevalence of obstructive sleep apnea risk and quality of sleep in chronic liver cell disease patients admitted to a tertiary care centre

Abstract

Introduction: Cirrhosis and associated complications result in significant morbidity and mortality. In the absence of a liver transplant, the prognosis, and the quality of life of decompensated cirrhosis patients are dismal. Hepatic encephalopathy, a complication of cirrhosis; defined as potentially reversible neuropsychiatric abnormalities seen in patients with liver dysfunction, has sleep disturbances as an integral part. But cirrhosis patients also suffer from various other sleep disorders including obstructive sleep apnea (OSA) which are independent of hepatic encephalopathy manifestations. But diagnosing OSA is challenging in this patient population. But when diagnosed early OSA can be treated successfully preventing further complications and improving the quality of life of cirrhotic patients. Methods: A cross-sectional study was conducted among cirrhosis patients admitted to Colombo South Teaching Hospital using investigator administered questionnaires to assess the risk of OSA. Internationally validated STOP­Bang and Pittsburgh Sleep Quality Index (PSQI) were used to screen for OSA and sleep quality respectively.Results: Out of 42 participants, two-thirds were males, and the mean age of the study population was 58 years. Most of the patients were in Child-Pugh class C (76.2%) Of the study population, 38.1 % were having high STOP­Bang scores (>5) and were in the high-risk group for obstructive sleep apnea. The percentage of poor sleepers with PSQI scores of more than 5 was as high as 85.7%. Higher severity of cirrhosis was associated with high PSQI scores and high-risk STOPBANG scores. Having ascites conferred a high risk for OSA. Conclusions: Higher severity of cirrhosis is associated with poorer sleep quality as well as increased risk for OSA.