Effect of an oral branched chain amino acid‐enriched snack in cirrhotic patients with sleep disturbance

Abstract

Aim: Sleep is closely related to physical and mental health. Sleep disturbance is reported in patients without encephalopathy. We examined the relationship among cirrhotic symptoms, laboratory data and sleep disturbances. Next, we examined the influence of a branched chain amino acid (BCAA) supplement on sleep disturbance in cirrhotic patients. Methods: We investigated a total of 21 patients at Nagasaki University Hospital from January to June 2009. We constructed questionnaire items for the evaluation of cirrhotic symptoms. The items, as major symptoms of cirrhotic patients, were as follows: hand tremor, appetite loss, muscle cramp of foot, fatigue, decreased strength, anxiety, abdominal fullness, abdominal pain and a feeling of low energy. We used the Epworth Sleepiness Scale (ESS) for the evaluation of daytime hypersomnolence. Energy supplementation with a BCAA snack was performed as a late evening snack (LES). All patients were assessed at the time of entry into the study, and at 4 and 8 weeks. Results: It was found that BCAA snack, taken p.o. as an LES, improved the ESS for cirrhotic patients without encephalopathy. This beneficial result was recognized in the short term, 4 weeks after beginning of treatment. This study demonstrated the utility of BCAA supplementation for cirrhotic patients with sleep disturbance. However, the cirrhotic symptom‐related score was positively relation with the Child–Pugh score at the time of patient entry, and we were unable to identify the item that related to ESS. Conclusion: A BCAA snack is a useful drug for cirrhotic patients who do not have any overt encephalopathy, but who suffered from sleep disturbance.

Screening for minimal hepatic encephalopathy in patients with cirrhosis by cirrhosis-related symptoms and a history of overt hepatic encephalopathy

“…In this context, CSS is calculated using items from a cirrhosis symptom questionnaire that was developed in our previous study, and three of the 12 items in this tool are associated with sleep disturbances. Moreover, our previous study reported that CSS, excluding the scores for the three sleep disturbance-related items, is associated with liver damage (18). In the present study, three CSS items (hand tremors, appetite loss and decreased strength) were significantly associated with MHE, and these associations validate the previously reported associations between MHE and the following responses: 'I do not maintain balance', 'I act irritable or impatient with myself', 'I am not doing any of my usual physical recreations or activity' and 'I am eating much less than usual' (25).…”

“…An 'impact factor' for each item was calculated, which was defined as the product of the frequency of the item and the mean importance that the patients attributed to the item. The impact factor for each item ranged from 0 to 3, and the CSS was calculated as the sum of the impact factors (18). The Epworth Sleepiness Scale (ESS) (21) was used to evaluate daytime hypersomnolence; ESS scores range from 0 to 24, and a score of ≥10 indicates significant daytime hypersomnolence.…”

“…Therefore, a simple and effective screening method is urgently needed to identify patients with MHE. Our previous study reported that sleep disturbances in patients with cirrhosis are mainly caused by restless legs syndrome (RLS) (17), and that Child-Pugh scores (CPS) are associated with cirrhosis-related symptom scores (CSS), which are calculated using questionnaire items that were developed in our previous study (18). Furthermore, sleep disturbances and RLS could be accurately diagnosed using this questionnaire and the sleep disturbances in patients without OHE improved following consuming a branched-chain amino acid (BCAA)-enriched snack (18).…”

“…Our previous study reported that sleep disturbances in patients with cirrhosis are mainly caused by restless legs syndrome (RLS) (17), and that Child-Pugh scores (CPS) are associated with cirrhosis-related symptom scores (CSS), which are calculated using questionnaire items that were developed in our previous study (18). Furthermore, sleep disturbances and RLS could be accurately diagnosed using this questionnaire and the sleep disturbances in patients without OHE improved following consuming a branched-chain amino acid (BCAA)-enriched snack (18). Moreover, our previous study reported that patients who underwent living donor liver transplantation also experienced sleep disturbances, which were caused by RLS, sleep apnea syndrome and MHE (19).…”

Hepatitis C virus‐related symptoms, but not quality of life, were improved by treatment with direct‐acting antivirals

“…The restless legs syndrome (RLS) is a common complication of cirrhosis and affects sleep status as evaluated by the Pittsburg sleep quality index (PSQI), and QOL is evaluated by the SF‐36 . The Epworth sleepiness scale (ESS) in patients with cirrhosis can be improved by ingestion of branched chain amino acid supplements . Previously, we used these PROs and could evaluate changes in symptoms in response to liver transplantation and supplementation …”