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Volume 10 No. 01
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Accepted Papers

Scientific Investigations

The Effects of Poor Sleep Quality on Cognitive Function of Patients with Cirrhosis

Charmaine A. Stewart, M.D.1; Robert Auger, M.D., F.A.A.S.M.3; Felicity T. B. Enders, Ph.D.2; Donna Felmlee-Devine, M.A.3; Glenn E. Smith, Ph.D.3
1Division of Gastroenterology and Hepatology, Department of Internal Medicine University of Illinois at Chicago, Chicago, IL; 2Division of Biostatistics, Department of Health Sciences Research; 3Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN


This study was conducted to assess the ill-defined relationship between sleep quality and multiple, specific domains of cognitive function in patients with cirrhosis.


A comprehensive battery of neuropsychological tests (divided into six neurocognitive domains) and a standardized, validated measure of sleep quality (Pittsburgh Sleep Quality Index [PSQI]) were administered to patients with cirrhosis and without evidence of overt hepatic encephalopathy, recruited from liver transplant and advanced liver disease clinics (n = 34). An inflammatory bowel disease (IBD) control group (n = 23) was similarly recruited and evaluated to control for the secondary effect of a chronic illness on cognition. PSQI global and component scores were used to predict cognitive function in each neurocognitive domain, using linear regression


Global PSQI scores were significantly higher (indicating poorer sleep quality) in the cirrhosis group (median [range] = 10 [1-19]) than in IBD controls = 5 (1-14); p = 0.002). After controlling for age and education, short duration of sleep was associated with impaired memory for patients with cirrhosis; the use of soporific agents was associated with poor visual-perceptual function in patients with IBD.


Poor sleep was associated with worsening of the already impaired cognitive function of patients with cirrhosis.


Stewart CA; Auger R; Enders FTB; Felmlee-Devine D; Smith GE. The effects of poor sleep quality on cognitive function of patients with cirrhosis. J Clin Sleep Med 2014;10(1):21-26.

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