Minjee Kim, MD: Understanding Sleep’s Impact on Post-Liver Transplant Outcomes

Findings from a recent study are providing clinicians with an overview of the association between poor sleep and different facets of patients’ physical and mental health following liver transplantation.

The research was presented at The Liver Meeting 2024 from the American Association for the Study of Liver Diseases (AASLD) in San Diego, California, by Minjee Kim, MD, an associate professor of neurology at Northwestern University Feinberg School of Medicine. Study results suggest subjective sleep disturbance is linked to poor mental and physical health, whereas objective poor sleep efficiency is associated with concurrent frailty following liver transplantation.

“Poor sleep in general is very common in people with chronic liver disease,” Kim told HCPLive. “Perhaps the logical expectation is that it should get better once your liver function improves after transplantation. But, it turns out that that's not the case, at least not always… We know that this burden of poor sleep after transplantation is high.”

Kim went on to describe the frustrations faced by patients and clinicians alike regarding the current lack of effective approaches to sleep management in this population.

In an effort to better understand the impact of poor sleep on outcomes after liver transplantation, investigators leveraged data derived from the NIDDK-funded, prospective LivCog cohort study conducted at 4 US transplant centers. Patients wore a wrist actigraphy for 8 consecutive days to measure time in bed, sleep duration, and sleep efficiency 90±30 days after liver transplant. Binary variables were created for short sleep duration, defined as < 6 hours, and poor sleep efficiency, defined as < 80% time spent sleeping while in bed.

Investigators defined subjective sleep disturbance as a PROMIS Sleep Disturbance T-score >55. Frailty was defined as a Liver Frailty Index ≥4.5, and quality of life measures were assessed through PROMIS Physical Function, Fatigue, Anxiety, and Depression subscales.

Among 99 liver transplant recipients with valid actigraphy data at 80 days post-liver transplant, the median age was 57 years, 39% were female, and 72% were White. Patients spent 7.0 (5.7, 7.9) hours in bed, achieving 5.9 (4.4, 6.8) hours of sleep with 85 (80, 89)% efficiency. Investigators observed short sleep duration and poor sleep efficiency in 57% and 26% of patients, respectively, while subjective sleep disturbance was observed in 45%.

Upon analysis, female sex (adjusted odds ratio [aOR], 1.22; 95% CI 1.04-1.45) and alcohol-associated liver disease (aOR, 1.38; 95% CI, 1.13-1.68) were positively associated with subjective sleep disturbance. Of note, no significant difference in objective sleep duration, efficiency, or midpoint was observed by subjective sleep disturbance. However, post-transplant physical frailty (17%), poor physical function (61%), fatigue (44%), anxiety (29%), and depression (24%) were common.

Further analysis revealed poor sleep efficiency was significantly associated with frailty (aOR, 1.29; 95% CI, 1.05-1.57), while subjective sleep disturbance was associated with poor physical function (aOR, 1.22; 95% CI, 1.01-1.48), fatigue (aOR, 1.36; 95% CI, 1.13-1.63), anxiety (aOR, 1.28; 95% CI, 1.02-1.59), and depression (aOR, 1.29; 95% CI, 1.10-1.51).

“I'm a firm believer that this is a very important topic, certainly for patients, so we need to care about it more as clinicians and researchers. I hope that there are more research studies going on focused on this topic so that we can better understand the dynamic interactions between the brain and the liver, which ultimately will help us figure out interventions to help patients sleep better, think better, and live better,” Kim said.

Reference

^{Kim M, Schaubel D, Gurian A, et al. Sleep Disturbance is Associated with Frailty, Impaired Physical Function, Fatigue, Anxiety, and Depression in Liver Transplant Recipients: Results from the LivCog Cohort Study. Paper presented at: AASLD’s The Liver Meeting 2024. San Diego, California. November 15-19, 2024.}