December 4, 2013

Active at night, sleepy all day - sleep disturbances in patients with hepatitis C virus infection

Journal of Hepatology

Article in Press

Meike Heeren, Faina Sojref, Ramona Schuppner, Hans Worthmann, Henning Pflugrad, Anita B. Tryc, Thomas Pasedag, Karin Weissenborn

Received 19 June 2013; received in revised form 23 November 2013; accepted 26 November 2013. published online 04 December 2013.
Accepted Manuscript


Background and Aims

More than 50% of patients with chronic hepatitis C with only mild liver disease complain about chronic fatigue, daytime sleepiness and poor sleep quality. The aim of the present study was to characterize and objectify the sleep disturbances in hepatitis C virus-infected patients.


Twenty-five women who had been infected with hepatitis C virus contaminated anti-D immunoglobulin in 1978/79 and 22 age-matched female healthy controls underwent actigraphy over a period of 5 days to measure motor activity and thereby sleep-wake-rhythm and in addition completed questionnaires for depression, health-related quality of life, fatigue and sleep and a sleep diary. Liver cirrhosis, a history of neurological or psychiatric disease, history of intravenous drug abuse, shift work, or current medication with effect upon the central nervous system were exclusion criteria.


The patients achieved higher scores for depression, fatigue and sleep disturbances and lower quality of life scores than the healthy controls. Actigraphy showed higher nocturnal activity and worse sleep efficiency in the patients, while the 24-hour activity level did not differ between groups. Fatigue and quality of life scores correlated with bad sleep quality and daytime sleepiness.


Our data indicate that chronic fatigue is associated with bad sleep quality and increased nocturnal activity in HCV-infected patients suggesting an alteration of sleep architecture behind fatigue in HCV-associated encephalopathy.

Abbreviations: APRI, aspartate aminotransferase-to-platelet ratio index, PSQI, Pittsburgh Sleep Quality Index, ESS, Epworth Sleepiness Scale, FIS, Fatigue Impact Scale, BDI, Becks Depression Inventory, HADS, Hospital Anxiety and Depression Scale, SF-36, Short-Form questionnaire, QoL, Quality of Life, WASO, wake after sleep onset, cpm, counts per minute, MVPA, moderate to vigorous physical activity,CSF, Cerebrospinal fluid, FSS, Fatigue Severity Scale

Keywords: Actigraphy, Fatigue, Hepatitis C, Sleep disturbances

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