Decrease of Grip Strength is Associated with Progression of Sleep
Disturbance in Chronic Liver Diseases
Abstract
Background and aims: The causal relationship between sarcopenia and
sleep disorder in patients with chronic liver disease (CLDs) is unclear.
We aimed examine the influence of sarcopenia-related factors (grip
strength (GS) and muscle mass) on the progression of sleep disorder in
patients with chronic liver disease (n=182, 46 cirrhotic cases, median
age=64 years). Methods: Sleep quality was evaluated by the Japanese
version of Pittsburgh Sleep Quality Index (PSQI-J). PSQI-J
>6 points was defined as sleep disorder. In all analyzed
patients, evaluation using PSQI-J questionnaire was performed twice or
more during the follow-up period. Time interval from the date of
baseline PSQI-J and the first confirmed date of elevation of PSQI-J
score was calculated. Our primary endpoint was the elevation of PSQI-J
score compared to the baseline PSQI-J score. GS decline was diagnosed
with a GS of <26 kg for male and <18 kg for female.
Loss of muscle mass was diagnosed by a skeletal muscle index of
<7.0 kg/m2 for male and <5.7 kg/m2 for female on
bioelectrical impedance analysis. Results: The median PSQI-J score was
5. PSQI-J >6 points at baseline was found in 83 patients
(45.6%). In patients with GS decline (n=48), the 3-year cumulative
elevation rate of PSQI-J score was 82.4%, while in patients with GS
non-decline, that was 36.2% (P<0.0001). In patients with SMI
decline (n=64), the 3-year cumulative elevation rate of PSQI-J score was
60.6%, while in patients with SMI non-decline, that was 43.4%
(P=0.1822). On the multivariate analysis of factors associated with the
elevation of PSQI-J score, only GS decline (P=0.0002) was a significant
factor. Conclusions: Reduced GS rather than loss of muscle mass is
independently associated with an elevated risk for the progression of
sleep disorder in CLD patients.