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Assessment of sleep pattern and quality before and after liver transplantation using different methods.

ABSTRACT: BACKGROUND/AIMS:Sleep disorders (SDs) are frequently seen in patients with liver cirrhosis. Polysomnography (PSG), actigraphy, and electroencephalogram (EEG) are the common objective methods to diagnose SDs. The most commonly used subjective methods are the Pittsburgh sleep quality index (PSQI) and Epworth sleepiness scale (ESS). We aimed to evaluate the effect of liver transplantation (LTx) on SDs using a combination of objective (PSG and EEG) and subjective (PSQI and ESS) methods. MATERIALS AND METHODS:A total of 18 patients with cirrhosis on an LTx waiting list were included in this study. Patient clinical status and biochemical parameters were evaluated. All patients completed the validated Turkish forms of the PSQI and ESS before and 9 months after LTx. All patients underwent EEG and PSG before and 9 months after LTx. RESULTS:In total, 18 patients with liver cirrhosis (men: 12; 66.7%, mean age: 53.22±10.43 years) were included in this study. Pretransplant mean PSQI and ESS scores were 8.4±3.11 and 7.28±3.89, respectively; 9-month posttransplant mean PSQI and ESS scores were 4.5±2.8 and 4.72±2.91 (p<0.01), respectively. Before transplantation, metabolic encephalopathy was detected in 6 patients by EEG, whereas metabolic encephalopathy was detected in only 1 patient posttransplant. Posttransplantation PSG sleep duration (all stages) increased relative to pretransplant PSG values. Sleep latency and rapid eye movement latency were found to be reduced compared to the pretransplant values. CONCLUSION:This pilot study compared SDs in patients with pre- and post-LTx by combining the subjective and objective methods. Significant SD improvements were found at the 9th month.

SUBMITTER: Gencdal G

PROVIDER: S-EPMC7498188 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Assessment of sleep pattern and quality before and after liver transplantation using different methods.

Gençdal Genco G Türker Gamze G Yazıcı Gençdal Işıl I Ekinci Burçak B Acar Şencan Ş Dinçkan Ayhan A Akyıldız Murat M

The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology 20200801 8

<h4>Background/aims</h4>Sleep disorders (SDs) are frequently seen in patients with liver cirrhosis. Polysomnography (PSG), actigraphy, and electroencephalogram (EEG) are the common objective methods to diagnose SDs. The most commonly used subjective methods are the Pittsburgh sleep quality index (PSQI) and Epworth sleepiness scale (ESS). We aimed to evaluate the effect of liver transplantation (LTx) on SDs using a combination of objective (PSG and EEG) and subjective (PSQI and ESS) methods.<h4>M ...[more]

PMID: 32915146

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Project description:Sleep quality decreases with aging and thus sleep complaints are prevalent in older adults, particularly for those with cognitive impairment and dementia. For older adults, emerging evidence suggests poor sleep quality increases risk of developing cognitive impairment and dementia. Given the aging population-and the impending economic burden associated with increasing numbers of dementia patients-there is pressing need to improve sleep quality among older adults. As such, research efforts have increased focus on investigating the association between age-related sleep changes and cognitive decline in older adults. Sleep quality is a complex construct to evaluate empirically, and yet the Pittsburg Sleep Quality Index (PSQI) is commonly used in studies as their only measure of sleep quality. Furthermore, the PSQI may not be the best sleep quality measure for older adults, due to its reliance on the cognitive capacity to reflect on the past month. Further study is needed to determine the PSQI's validity among older adults. Thus, the current study examined sleep quality for 78 community dwelling adults 55+ to determine the PSQI's predictive validity for objective sleep quality (as measured by actigraphy). We compared two subjective measures of sleep quality-the PSQI and Consensus Sleep Diary (CSD)-with actigraphy (MotionWatch 8©; camntech). Our results suggest perceived sleep quality is quite different from objective reality, at least for adults 55+. Importantly, we show this difference is unrelated to age, gender, education, or cognitive status (assessed using standard screens). Previous studies have shown the PSQI to be a valuable tool for assessing subjective sleep quality; however, our findings indicate for older adults the PSQI should not be used as a substitute for actigraphy, or vice versa. Hence, we conclude best practice is to include both subjective and objective measures when examining sleep quality in older adults (i.e., the PSQI, CSD, and actigraphy).

Project description:BackgroundMitochondrial succinate accumulation has been suggested as key event for ischemia reperfusion injury in mice. No specific data are however available on behavior of liver mitochondria during ex situ machine perfusion in clinical transplant models.MethodsWe investigated mitochondrial metabolism of isolated perfused rat livers before transplantation. Livers were exposed to warm and cold ischemia to simulate donation after circulatory death (DCD) and organ transport. Subsequently, livers were perfused with oxygenated Belzer-MPS for 1h, at hypothermic or normothermic conditions. Various experiments were performed with supplemented succinate and/or mitochondrial inhibitors. The perfusate, liver tissues, and isolated mitochondria were analyzed by mass-spectroscopy and fluorimetry. Additionally, rat DCD livers were transplanted after 1h hypothermic or normothermic oxygenated perfusion. In parallel, perfusate samples were analysed during HOPE-treatment of human DCD livers before transplantation.FindingsSuccinate exposure during rat liver perfusion triggered a dose-dependent release of mitochondrial Flavin-Mononucleotide (FMN) and NADH in perfusates under normothermic conditions. In contrast, perfusate FMN was 3-8 fold lower under hypothermic conditions, suggesting less mitochondrial injury during cold re-oxygenation compared to normothermic conditions. HOPE-treatment induced a mitochondrial reprogramming with uploading of the nucleotide pool and effective succinate metabolism. This resulted in a clear superiority after liver transplantation compared to normothermic perfusion. Finally, the degree of mitochondrial injury during HOPE of human DCD livers, quantified by perfusate FMN and NADH, was predictive for liver function.InterpretationMitochondrial injury determines outcome of transplanted rodent and human livers. Hypothermic oxygenated perfusion improves mitochondrial function, and allows viability assessment of liver grafts before implantation.Fundingdetailed information can be found in Acknowledgments.

Project description:IntroductionDespite the importance of sleep, the assessment of sleep quality does not form part of standard clinical care in intensive care unit (ICU). Continuous assessment of self-reported quality of ICU patients' sleep has been strongly recommended. Prior to implementing such an assessment in the ICU, it is important to assess the acceptability of this method of assessment to the ICU's patients. The aims of this study were to assess the acceptability to ICU patients of completing daily self-reports on sleep quality during their ICU stay and to assess ICU patients' self-reported sleep quality and sleep disruptive factors during their time in ICU.MethodsAn observational prospective-repeated assessment was conducted on n=120 patients in an ICU in Saudi Arabia. The participants were both intubated and non-intubated.Outcomes measuresOver a 3-month period, sleep quality was assessed using the Arabic version of the Richards-Campbell Sleep Questionnaire (RCSQ-A), and self-reported sleep disruptive factors were identified. Clinical factors, such as ICU interventions, and previously administered sedatives were also examined. The patients' acceptance of completing daily RCSQ-A reports was assessed using various indicators of acceptability.ResultsA total of 381 self-reports (RCSQ-A) were collected for this analysis. The patients reported 34.4±5.60, indicating that sleep quality was poor on average. The group of intubated patients reported much poorer sleep quality during intubation than after extubation. In the multivariate analysis, factors which most significantly affected sleep (exp(b), p value) were midazolam (-6.424, p<0.0005), propofol (-3.600, p<0.05), noise (-1.033, p<0.05), gender (1.836, p<0.05), daytime sleepiness (0.856, p<0.05) and the presence of mechanical ventilation (-1.218, p<0.05).ConclusionThe acceptability and feasibility of using daily RCSQ-A for sleep quality assessment was demonstrated. Sleep quality was reported as poor by all participants and the factors affecting sleep were varied. This study provided various recommendations for healthcare providers and researchers in terms of evaluating and improving sleep quality in ICU patients.

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Assessment of sleep pattern and quality before and after liver transplantation using different methods.

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Assessment of sleep pattern and quality before and after liver transplantation using different methods.

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