Sleep Problems Associated with Chronic Hepatitis C, Even If No Cirrhosis

Fitful nights of sleeplessness and daytime fatigue were more common among people with hepatitis C regardless of whether they had cirrhosis of the liver when compared to the healthy control group involved in a small study published in the Journal of Hepatology.

The practice of clinical hepatologists has been dominated in recent decades by patients who have chronic hepatitis C virus (HCV), and several studies have addressed the impact of cirrhosis on sleep quality, according to an article in the April issue of Journal of Hepatology by Daniel Shouval, MD, a liver diseases consultant at the Hadassah Medical Center in Israel and journal co-editor. However, less attention has been given to sleep abnormalities among those HCV patients without cirrhosis, said Shouval.

It can be difficult to isolate the cause of fatigue and insomnia as either organic or stemming from psychiatric disorders from chronic liver disease, according to Shouval. Serious emotional, mental, and physical consequences can occur when sleep and circadian rhythm are disrupted, such as exhaustion, irritability, depression, drowsiness, and weight gain.

Complaints about chronic fatigue, daytime sleepiness, and poor sleep are common in more than 50 percent of patients with mild liver disease. The aim of the study, conducted by Meike Heeren, MD, and colleagues from the Hannover Medical School in Germany, was to characterize and objectify the sleep disturbances in patients infected with HCV.

The subjects studied were 20 women with an average age of 56 who had been infected with HCV-contaminated anti-D immunoglobulin in the late 1970s, and a separate control group of 22 healthy women of matching ages. Among the 20 anti-HCVpositive genotype 1b patients, 12 were still HCV-RNA positive by polymerase chain reaction assay.

The study design featured a broad, complex methodology to assess study variables that included several participant questionnaires to measure sleep quality, daytime sleepiness, daily activity fatigue, depression, emotions, and health. Participants also kept sleep diaries and wore an actigraph wrist device to monitor motor activity for sleep/wake rhythm.

Researchers analyzed measurement scores and a Spearman correlation test to evaluate a relationship between fatigue, quality of life, sleep parameters, and actigraphy results. The measurements showed that the women with HCV had higher marks for depression, fatigue, and sleep disturbances and lower marks for quality of life compared to the women in the control group. Those with HCV also had higher nocturnal activity and poorer sleep, according to actigraphy results. However, 24-hour activity level showed no differences from one group to the other.

The study results indicate that regardless of whether they have cirrhosis, people with hepatitis C more often develop disrupted circadian rhythm and as a result sleep-related disturbances than do people without the disease. Confirming previous observations, they show that the consequences of sleep disruption should be regarded as an extra hepatic manifestation of chronic hepatitis C, according to Shouval.

“In summary the discussed report provides descriptive evidence that a history of past or present mild chronic hepatitis C virus infection even without clinical evidence for cirrhosis or "traditional" hepatic encephalopathy is associated with an altered sleep pattern which has a negative impact on quality of life and wellbeing,” concluded Shouval.

Not visited in the study are identification of mechanisms involved in the sleep disturbance and its consequences in chronic HCV, noted Shouval. That remains a goal of future research, he said.