EncephalApp Stroop App predicts poor sleep quality in patients with minimal hepatic encephalopathy due to hepatitis B-induced liver cirrhosis

Abstract

Background/Aim: A novel computerised Stroop test- EncephalApp Stroop App (EncephalApp) has good diagnostic validity for minimal hepatic encephalopathy (MHE) in cirrhotic patients. The Stroop test is correlated with sleep disturbances which are common, and severely affects health-related quality of life in cirrhotic patients with MHE. We evaluated the relationship between sleep quality and EncephalApp results in patients with MHE due to hepatitis B-induced liver cirrhosis. Patients and Methods: We enrolled 180 adult patients with hepatitis B-induced cirrhosis. All patients were tested using the psychometric hepatic encephalopathy score (PHES) and EncephalApp. We analysed the diagnostic validity of EncephalApp for MHE using PHES as the gold standard for reference. The sleep quality of included patients was evaluated using the Pittsburgh Sleep Quality Index (PSQI). The predictive factors for poor sleep quality were analysed using backwards conditional stepwise logistic regression analysis. Results: Ninety-eight patients (54.4%) were diagnosed with MHE by PHES. Receiver operating characteristic (ROC) curve analysis showed that the threshold value of EncephalApp for MHE diagnosis was 225.60 s. EncephalApp showed 85.2% sensitivity and 77.3% specificity for diagnosing MHE; the area under the ROC curve was 0.864. PSQI scores of cirrhotic patients with MHE were significantly lower than those without MHE ( P < 0.05). Child Turcotte Pugh grades (Odds ratio [OR] = 2.11 [1.55–2.85], P < 0.01) and the total Off-time plus On-time of EncephalApp (OR = 4.14 [1.95–6.29], P < 0.01) were independent predictors of poor sleep quality in MHE patients. Conclusions: The total Off-time plus On-time of EncephalApp predicts poor sleep quality in patients with MHE due to hepatitis B-induced cirrhosis.

Integrating smart phone applications in the management of cirrhotic patients: A scoping review

“…That led them to conclude that the EncephalApp had good sensitivity in diagnosing minimal HE. Lou et al 16 assessed the EncephalApp from a different perspective and found that the use of the mobile app could predict poor sleep quality in patients with cirrhosis secondary to hepatitis B, with good sensitivity and specificity for diagnosing minimal HE (85.2% and 77.3%, respectively).…”

Comprehensive Overview of Sleep Disorders in Patients with Chronic Liver Disease

“…In practice, the prevalence of MHE varies between 30% and 70% and is suspected in cirrhotic patients who have abnormalities on psychometric testing, particularly impaired attention and reaction speed [ 130 ]. It has also been demonstrated that PHES score is significantly correlated with PSQI and ESS scores in a study conducted among 100 patients with cirrhosis [ 34 ].…”