The use of rifaximin improves sleep disorders in Hepatic Encephalopathy

Abstract

Background and aim: Hepatic Encephalopathy (HE) is a complication of cirrhosis and may lead to overt neurological signs. Sleep disorders are frequent in HE and alter the quality of life. Rifaximin is accepted as the treatment of overt HE. This study aimed to assess the effect of rifaximin on sleep disorders in overt HE. Methods: This was a pilot, crossover study involving all patients suffering from cirrhosis and overt HE admitted in our Liver Unit (June 2014- January 2015). The West Haven criteria assessed the HE severity (WH score). Patients underwent a 24-h polysomnography (PSG), and a 7-days actigraphy. They fulfilled questionnaires: Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety Depression scale (HAD). At the end of a one-month course of rifaximin, the same assessment was repeated. Results: Ten patients were included: six males, mean age 57±12 y. Child scores range from B7 to C15. Before rifaximin, WH score was 2.5±0.5, and PSG revealed a long sleep time on 24 h (698±240 min). Sleep quality was deteriorated with few stage 3 sleep (6% (0-39)) and REM sleep (6% (3-23)). Actimetry confirmed prolonged mean sleep time/24h (556 min (183-808)). Questionnaires showed an impaired sleep quality (mean score of 11±4 on PSQI), and symptoms of anxiety and depression (HAD A 10+5, HAD D 12+6). After rifaximin, the WH score decreased: 1.7±0.5. Sleep quality was improved on PSG: stage 3 sleep increased to 32% (6-56), p=0.04, and REM sleep to 11% (0-27), p=0.04. Sleep time/24h decreased to 290 (53-701) min, p=0.03 on actigraphy. No changes were observed on questionnaires. Conclusion: Rifaximin as a treatment of overt HE is associated with decreased sleep time/24h and significant improvement in sleep quality.