Sleep disturbances are common in patients of
cirrhosis with minimal
hepatic encephalopathy (MHE) and affect health related quality of life (HRQOL). No study has evaluated effect of
lactulose on sleep disturbances and correlation with HRQOL in patients with MHE. We assessed sleep disturbances in
cirrhosis with MHE and effect of
lactulose on sleep disturbances and HRQOL. One hundred patients of
cirrhosis [MHE; (n = 50, age 45.3 ± 11.2 years, 45 males) no-MHE (n = 50, age 46.3 ± 10.4 years, 44 males)] were included. MHE was diagnosed with psychometric
hepatic encephalopathy score (PHES) ≤ -5. All patients underwent laboratory parameters including arterial
ammonia and critical flicker frequency (CFF) Sleep disturbances were measured with Pittsburgh Sleep Quality Index (PSQI), Epworth
Sleepiness Scale (ESS) and polysomnography. HRQOL was measured with SF-36(v2) questionnaire. Patients with MHE were given
lactulose therapy for 3 months and all the parameters were repeated. Poor quality of sleep and excessive day time
sleepiness were more common in patients with MHE, compared to without MHE. With
lactulose therapy there was improvement in MHE in 21 patients and arterial
ammonia levels (93.74 ± 14.8 vs. 71.44 ± 18.8 μmol/L: p < 0.001), CFF (34.83 ± 3.54 vs. 39.44 ± 4.95 Hz: p < 0.001), PHES (-7.64 ± 2.1 vs. -5.58 ± 2.09: p < 0.001), PSQI (8.6 ± 3.3 vs. 5.2 ± 1.5: p < 0.001), ESS (12.52 ± 3.01 vs. 9.24 ± 2.27: p < 0.001) and HRQOL (p = 0.01). Excessive day time
sleepiness and impaired sleep quality are common in patients with MHE and correlate with neuropsychiatric impairment. Improvement in MHE with
lactulose also leads to improvement in sleep disturbances and HRQOL.