Symptoms of daytime sleepiness and sleep apnea in liver cirrhosis patients

Al Enezi Abdullah, Fares Al-Jahdali, Anwar E. Ahmed, Nahid Shirbini, Al Harbi Abdullah, Baharoon Salim, Yosra Z. Ali, Aljumah Abdulrahman, Mohd Khan, Abdullah Khaleid, Al Jahdali Hamdan*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Background/propose. Sleep disturbance and excessive daytime sleepiness (EDS) have been reported in patients with hepatic cirrhosis with no hepatic encephalopathy (HE). The objective of this study was to evaluate daytime sleepiness and risk of obstructive sleep apnea (OSA) among liver cirrhosis patients. Material and methods. A cross-sectional study was conducted at King Abdulaziz Medical City (KAMC)-Riyadh over a period of six months, using a structured questionnaire that investigated: 1) Sleep patterns and daytime sleepiness using the Epworth Sleeping Scale (ESS), and 2) The risk for sleep apnea using the Berlin Questionnaire (BQ). We enrolled patients with a confirmed diagnosis of liver cirrhosis who were being followed at the hepatology and pre-liver transplant clinics. Results. We enrolled 200 patients with liver cirrhosis, 57.5% of whom were male. The mean age was 60 (± SD 12.2). The reported prevalence of EDS, OSA, and both EDS and OSA were 29.5%, 42.9%, and 13.6%, respectively. The prevalence of EDS was higher in patients with Hepatitis-C and patients with DM, who experienced short sleep duration. We did not find any association between the severity of liver disease and EDS or OSA as measured by Child-Pugh scores (CPS). Conclusions. The risk of OSA and EDS is high among liver cirrhosis patients. Those patients with cirrhosis secondary to Hepatitis C are at higher risk of EDS and OSA. Both EDS and OSA affect patients designated as CPS Class A more frequently than patients designated as CPS Class B.

Original languageEnglish
Pages (from-to)591-598
Number of pages8
JournalAnnals of Hepatology
Issue number4
StatePublished - 2017
Externally publishedYes


  • CPS
  • Child-Pugh scores
  • Excessive daytime sleepiness
  • Hepatitis B
  • Hepatitis C
  • Insomnia
  • Leep apnea
  • Liver cirrhosis
  • Sleep disturbances


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