Effects of Obstructive Sleep Apnea on Sleep Quality, Cognition, and Driving Performance in Patients With Cirrhosis

• Published in: Clinical gastroenterology and hepatology Vol. 13; no. 2; pp. 390 - 397.e1
• Main Authors: Bajaj, Jasmohan S, Thacker, Leroy R, Leszczyszyn, David, Taylor, Samuel A, Heuman, Douglas M, Raman, Shekar, Sterling, Richard K, Siddiqui, Muhammad S, Stravitz, R. Todd, Sanyal, Arun J, Puri, Puneet, Luketic, Velimir, Matherly, Scott, Fuchs, Michael, White, Melanie B, Noble, Nicole A, Unser, Ariel B, Wade, James B
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2015
• Subjects: Adult; Aged; Automobile Driving; Chronic Liver Disease; Cognition; Continuous Positive Airway Pressure; Covert Hepatic Encephalopathy; CPAP; Cross-Sectional Studies; Female; Gastroenterology and Hepatology; Humans; Liver Cirrhosis - complications; Male; Middle Aged; Minimal Hepatic Encephalopathy; Prospective Studies; Sleep Apnea, Obstructive - complications; Sleep Apnea, Obstructive - therapy; Sleep Wake Disorders; obstructive sleep apnea; Epworth Sleepiness Scale; Chronic Liver Disease; AHI; CPAP; ESS; body mass index; inhibitory control test; NCT-A/B; continuous positive airway pressure; Pittsburgh Sleep Quality Index; Covert Hepatic Encephalopathy; apnea–hypopnea index; hepatic encephalopathy; Minimal Hepatic Encephalopathy; ICT; number connection test A/B; OSA; HE; PSQI; BMI
• ISSN: 1542-3565; 1542-7714
• DOI: 10.1016/j.cgh.2014.08.028

Background & Aims In patients with cirrhosis, sleep disturbances are assumed to result from hepatic encephalopathy (HE). The effects of obstructive sleep apnea (OSA) on cognition, sleep parameters, or driving in patients with cirrhosis are unclear. Methods We performed a cross-sectional and prospective study of 118 subjects. Subjects were assigned to 1 of 4 groups: those with OSA and cirrhosis (without hepatic encephalopathy or ascites, n = 34), those with cirrhosis only (n = 30), those with OSA only (n = 29), and those without OSA or cirrhosis (controls, n = 25). None of the OSA patients were receiving continuous positive airway pressure (CPAP) therapy. Subjects underwent cognitive testing (paper–pencil tests for psychomotor speed and attention, as well as executive function tests), sleep assessment (daytime sleepiness and night-time sleep quality), and a monotonous driving simulation (worsening lane deviations over time indicated poor performance). We also tested patients with OSA, with cirrhosis (n = 10) and without cirrhosis (n = 7), before and after CPAP therapy. Results Daytime sleepiness and sleep quality were worse in subjects in the OSA groups (with or without cirrhosis) than subjects with cirrhosis alone or controls. Of subjects with only OSA, 36% had impaired psychomotor speed and attention, compared with more than 60% of subjects in both cirrhosis groups. In contrast, executive function was uniformly worse in subjects with OSA, with or without cirrhosis, than groups without OSA. Simulator performance (lane deviations) worsened over time in both OSA groups. CPAP therapy significantly increased executive function and sleep quality, and reduced simulator lane deviations and sleepiness, in OSA subjects with and without cirrhosis. After CPAP therapy, performance on the paper–pencil test improved significantly only in subjects with OSA without cirrhosis. Conclusions OSA should be considered in evaluating sleep impairment in patients with cirrhosis. In patients with cirrhosis and OSA, psychomotor speed and attention issues likely are related to cirrhosis, whereas executive function and simulator performance are affected by OSA. CPAP therapy improves executive function and simulator performance in patients with OSA, regardless of cirrhosis.