Relationship Between Sleep–Wake Disturbance and Risk of Malnutrition in Hospitalized Patients With Cirrhosis

Abstract

Both sleep–wake disturbance and malnutrition are common in cirrhosis and might be associated with similar adverse outcomes, such as impaired health-related quality of life, hepatic encephalopathy, and sarcopenia, but there is no study investigating the relationship between these two. We aimed to explore the relationship between sleep–wake disturbance [estimated by the Pittsburgh Sleep Quality Index (PSQI)] and malnutrition risk [estimated by the Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT)]. About 150 patients with cirrhosis were prospectively recruited. The nutritional risk is classified as low (0 points), moderate (1 point), and high (2–7 points) according to the RFH-NPT score. A global PSQI >5 indicated poor sleepers. Furthermore, multivariate linear regression analyses were performed to determine the relationship between sleep–wake disturbance and malnutrition. The median PSQI was seven, and RFH-NPT was two in the entire cohort, with 60.67 and 56.67% rated as poor sleep quality and high malnutrition risk, respectively. Patients with cirrhosis with poor sleep quality had significantly higher RFH-NPT score (3 vs. 1, P = 0.007). Our multivariate analyses indicated that male patients (β = 0.279, P < 0.001), ascites (β = 0.210, P = 0.016), and PSQI (β = 0.262, P = 0.001) were independent predictors of malnutrition. In addition, the differences regarding PSQI score were more significant in male patients, as well as those >65 years or with Child-Turcotte-Pugh class A/B (CTP-A/B) or the median model for end-stage liver disease (MELD) <15. Taken together, the sleep–wake disturbance is strongly correlated with high malnutrition risk in patients with cirrhosis. Given sleep–wake disturbance is remediable, it is tempting to incorporate therapies to reverse poor sleep quality for improving nutritional status in patients with cirrhosis.

Comparison of the GLIM criteria with specific screening tool for diagnosing malnutrition in hospitalized patients with cirrhosis: A descriptive cross‐sectional study

“…Notably, we suppose two issues—that is, etiology of cirrhosis and fluid accumulation—partly account for this ambiguity and discordance. Keeping this in mind, RFH‐NPT is emerging as a metric aimed at screening malnutrition risk, whose validity and reliability has been reported across several investigations and associated with a wide array of adverse events 30–32 . In this sample, RFH‐NPT identified 70.8% of participants as being at moderate‐high risk, and as a consequence, approximately one‐third of the population was confirmed as having GLIM criteria–defined malnutrition.…”

Sleep disturbances in patients with cirrhosis: Pursuing just right

“…A large, prospective, cross‐sectional study of 1098 outpatients with cirrhosis showed a dose–response relationship for a PSQI score > 5 (Child–Turcotte–Pugh [CTP] A: 16.9%, CTP B: 26.5%, and CTP C: 56.6%) and an ESS score > 10 (CTP A: 17.6%, CTP B: 29.7%, CTP C: 52.8%) 35 . However, our previous reports showed no significant difference in disease severity as measured by CTP classification or the model for end‐stage liver disease score between poor sleepers (patients with cirrhosis and a PSQI score > 5) and good sleepers 32,33 . Another study also demonstrated no correlation between the CTP classification model for end‐stage liver disease score and sleep disturbance in patients with cirrhosis 24 …”

“…Moreover, a higher PSQI score was associated with a higher risk of malnutrition. In addition, the differences related to the PSQI score were more pronounced in male patients, in patients younger than 65 years of age, and in patients with better hepatic reserve function 32 …”

Sleep quality and its associated factors among patients with tuberculosis: A cross-sectional study

“…Previous findings suggest that low albumin levels and sleep disturbances may have a mutual effect. Inflammation is thought to be an upstream factor that affects both sleep-wake disorder and malnutrition in a synergistic manner ( 40 ). Another biological mechanism influencing systemic metabolic rate is an increase in physiological indicators of hyperarousal in adults with objectively short sleep durations, which leads to an increase in cortisol and norepinephrine levels ( 39 ).…”