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Abstract Details
Sleep and liver disease: a bidirectional relationship
Thomas Marjot1, David W Ray2, Felicity R Williams3, Jeremy W Tomlinson2, Matthew J Armstrong4
Author information
1Oxford Centre for Diabetes Endocrinology and Metabolism, National Institute of Health Research Oxford Biomedical Research Centre, Churchill Hospital, University of Oxford, Oxford, UK; Oxford Liver Unit, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK. Electronic address: thomas.marjot@ndm.ox.ac.uk.
2Oxford Centre for Diabetes Endocrinology and Metabolism, National Institute of Health Research Oxford Biomedical Research Centre, Churchill Hospital, University of Oxford, Oxford, UK.
3Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK; Institute of Inflammation and Ageing, NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK.
4Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
Abstract
Sleep is a complex, highly regulated process essential for human health and wellbeing. Increasingly, sleep-wake disturbance has been implicated in the pathogenesis of chronic liver disease, particularly the development and progression of non-alcoholic fatty liver disease and alcohol-related liver disease. Patients with cirrhosis also have a high burden of sleep abnormalities with substantial implications for their quality of life and physical health. This Review summarises the epidemiology and pathophysiology of sleep-wake disturbance in liver disease and discusses the multiple converging pathways leading to abnormal sleeping patterns in patients with cirrhosis. This includes contributions from altered melatonin metabolism, neuromuscular complications, and aberrant thermoregulation. In turn, a vicious cycle is established whereby disrupted sleep can further contribute to liver disease progression. We also begin to unravel the complex, interlinking relationship between sleep-wake disturbance and hepatic encephalopathy, discussing both overlapping and distinct mechanisms and clinical features. Finally, we summarise the current and future therapeutic approaches aiming to improve sleep quality in patients with cirrhosis.