Sleep Pills May Not Enhance Quality of Life in Hepatocellular Carcinoma Patients

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A study revealed good sleep duration, sleep efficiency, and the use of sleep medications might not necessarily improve the quality of life for patients with hepatocellular carcinoma who experience sleep disturbances.¹ Rather, these individuals need interventions to improve general health and social functioning for better sleep latency and physical functioning for reduced daytime arousal difficulty.

“…the lack of correlation between the use of sleep aids and SF-36 suggests that the easy use of sleep medication is not a solution for sleep disorders in patients with [hepatocellular carcinoma],” wrote investigators, led by Toru Ishikawa, MD, PhD, from the department of gastroenterology and hepatology at Saiseikai Niigata Hospital.

Investigators noted sleeping pills depress the central nervous system and may induce hepatic encephalopathy in patients with hepatocellular carcinoma due to chronic liver disease.

“Therefore, the treatment for sleep disturbances in patients with [hepatocellular carcinoma] should be tailored to the underlying cause,” investigators wrote. “However, considering the risk of hepatic encephalopathy, the use of sleeping pills should be avoided, as evidenced by the lack of a correlation between QOL and sleep disturbances in the present study.”

Patients with hepatocellular carcinoma have as high as a 28.8% rate of intrahepatic recurrence within 2 years of diagnosis and treatment.² Additionally, the more a patient relapses, the more their fatigue increases.

In a retrospective study, investigators assessed the correlation between the Pittsburgh Sleep Quality Index (PSQI) subcategories and quality of life in patients with hepatocellular carcinoma.¹ The team sought to determine what sleep components required intervention to improve quality of life.

The study included 75 patients with recurrent hepatocellular carcinoma who were admitted to the Saiseikai Niigata Hospital from May 2021 to May 2023. Participants were included if they were aware of hepatocellular carcinoma recurrence, scheduled to undergo RFA or TACE, had no diseases requiring hospitalization other than hepatocellular carcinoma, had no metal allergy, and a performance status of Eastern Cooperative Oncology Group score 0 – 2.

The sample had a mean age of 70.3 ± 8.27 years with 78.6% of participants male. Among the participants, 12 had hepatitis C virus (16%), 13 had hepatitis B virus (16%), and 50 had non-HBV/non-HCV (68%). As for Child-Pugh scores, 55 participants scored class A (score 5 – 6). 17 participants scored class B (scores 7 – 9), and 3 participants scored class C (scores 10 – 15). Albumin-bilirubin grades were as followed: 30 cases in grade 1, 38 cases in grade 2, and 7 cases in grade 3.

Participants completed a Pittsburgh Sleep Quality Index (PSQI) questionnaire to evaluate sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, sleep medications, and daytime dysfunction. Moreover, participants filled out the 36-item Short Form Survey (SF-36) to assess the quality of life, specifically the items of physical functioning, role-physical, bodily pain, general health perception, vitality, social functioning, role-emotional

Investigators observed correlations between sleep quality, sleep disturbance, and SF-36 for most quality-of-life items: bodily pain (P < .01 and P < .01), general health perception (P < .01 and P < .01), mental health (P < .01 and P < .01), role-emotional (P < .01 and P < .01), role-physical (P < .01 and P < .01), social functioning (P = .02 and P < .01), and vitality (P < .01 and P < .01).

They also noted a correlation between sleep onset time and quality of life regarding bodily pain (P < .01), mental health (P = .07), physical functioning (P = .014), role-emotional (P < .01), role-physical (P < .01), and vitality (P = .013). The team also observed correlations between daytime dysfunction and SF-36 for all items (bodily pain: P < .01; general health perception: P < .01; mental health P < .01; role-emotional: P < .01; role-physical: P < .01; social functioning: P < .01; vitality: P < .01, except physical functioning (P = .12).

Moreover, no correlations were found between sleep duration, sleep efficiency, sleep medications, and SF-36 for any quality-of-life item.

Investigators wrote the findings were limited by the small sample of patients, not including patients on systemic therapy for hepatocellular carcinoma, and not analyzing the number of recurrences.

“In order to improve the [quality of life] of [hepatocellular carcinoma] survivors, it is important to understand their sleep status based on the PSQI and provide therapeutic intervention according to their subclass. Based on the analysis of PSQI and [quality of life], it is not expected that sleeping pills will solve the problem of recurrence of [hepatocellular carcinoma]. Further analysis of the causes of [hepatocellular carcinoma] cases related to sleep disorders is required in the future.”

References

1. ^{Ishikawa T, Arita N, Matsuhashi Y, Honma T. Relationship Between Sleep Quality and Quality of Life: Analysis of Hepatocellular Carcinoma Survivors. Cureus. 2024;16(7):e63883. Published 2024 Jul 5. doi:10.7759/cureus.63883}
2. ^{Kudo M, Izumi N, Kokudo N, et al. Report of the 22nd nationwide follow-up Survey of Primary Liver Cancer in Japan (2012-2013). Hepatol Res. 2022;52(1):5-66. doi:10.1111/hepr.13675}