Abnormalities in the 24‐hour rhythm of skin temperature in cirrhosis: Sleep‐wake and general clinical implications

• Published in: Liver International Vol. 37; no. 12; pp. 1833 - 1842
• Main Authors: Garrido, Maria, Saccardo, Desy, DE RUI, MICHELE, VETTORE, ELIA, VERARDO, ALBERTO, Carraro, Paolo, Di Vitofrancesco, Nicola, Mani, Ali R, ANGELI, PAOLO, BOLOGNESI, MASSIMO, MONTAGNESE, SARA
• Format: Journal Article
• Language: English
• Published: United States Wiley 01.12.2017; Wiley Subscription Services, Inc
• Subjects: Abnormalities; Aged; Body temperature; Case-Control Studies; Circadian Rhythm; circadian rhythm; hepatic failure; inflammatory marker; sleep latency; Cirrhosis; Female; hepatic failure; Humans; Inflammation; inflammatory marker; inflammatory markers; Liver Cirrhosis; Liver Cirrhosis - physiopathology; Male; Markers; Melatonin; Middle Aged; Patients; Skin; Skin Temperature; Sleep; Sleep and wakefulness; sleep latency; Temperature effects; Vasodilation; Wireless communications; inflammatory markers; sleep latency; hepatic failure; circadian rhythm
• ISSN: 1478-3223; 1478-3231; 1478-3231
• DOI: 10.1111/liv.13525

Background & Aims Sleep preparation/onset are associated with peripheral vasodilatation and a decrease in body temperature. The hyperdynamic syndrome exhibited by patients with cirrhosis may impinge on sleep preparation, thus contributing to their difficulties falling asleep. The aim of this study was the assessment of skin temperature, in relation to sleep‐wake patterns, in patients with cirrhosis. Methods Fifty‐three subjects were initially recruited, and 46 completed the study. Of the final 46, 12 were outpatients with cirrhosis, 13 inpatients with cirrhosis, 11 inpatients without cirrhosis and 10 healthy volunteers. All underwent baseline sleep‐wake evaluation and blood sampling for inflammatory markers and morning melatonin levels. Distal/proximal skin temperature and their gradient (DPG) were recorded for 24 hours by a wireless device. Over this period subjects kept a sleep‐wake diary. Results Inpatients with cirrhosis slept significantly less well than the other groups. Inpatients and outpatients with cirrhosis had higher proximal temperature and blunted rhythmicity compared to the other groups. Inpatients with/without cirrhosis had higher distal temperature values and blunted rhythmicity compared to the other groups. Inpatients and outpatients with cirrhosis had significantly lower DPG values compared to the other groups, and DPG reached near‐zero values several hours later. Significant correlations were observed between temperature and sleep‐wake variables and inflammatory markers. Conclusions Alterations of distal/proximal skin temperature, their gradient and their time‐course were observed in patients with cirrhosis, which may contribute to their sleep disturbances. See Editorial on Page 1776