Disturbed Sleep Patterns in Non-cirrhotic Hepatitis C Patients Receiving Interferon Alpha-2b Plus Ribavirin

2.50
Hdl Handle:
http://hdl.handle.net/10755/151856
Type:
Presentation
Title:
Disturbed Sleep Patterns in Non-cirrhotic Hepatitis C Patients Receiving Interferon Alpha-2b Plus Ribavirin
Abstract:
Disturbed Sleep Patterns in Non-cirrhotic Hepatitis C Patients Receiving Interferon Alpha-2b Plus Ribavirin
Conference Sponsor:Sigma Theta Tau International
Conference Year:2002
Conference Date:July, 2002
Author:Clark, Cinda
P.I. Institution Name:University of Texas at Houston
Title:Assistant Professor
Objective: The study objective was to describe the attributes of disturbed sleep patterns in hepatitis C (HCV) patients and contract these attributes to a control group of patients. Design: Prospective cross-sectional study. Population, Sample, Setting, Years: A convenience sample of 200 subjects from a major metropolitan university affiliated teaching facility was recruited from September 1999 to September 2001. Cohort 1 (control group) included 100 subjects with complaints of difficulty sleeping who were referred for diagnostic sleep studies and had no history of HCV or liver disease. Cohort 2 included 100 subjects with chronic active HCV, compensated liver disease, and no histologic evidence of cirrhosis receiving INF alpha-2b + ribavirin for 24 weeks. Concept and Variable Studied: The current standard therapy for chronic active hepatitis C is interferon plus ribavirin with the primary goal of treatment a sustained elimination of the HCV. The one difficulty in treating patients with hepatitis C is both the relatively low end of treatment response rate associated with interferon monotherapy (10% - 20%) and interferon plus ribavirin combination therapy (47% - 67%) and the side effect profile associated with this class of drugs. Maximizing treatment compliance and minimizing the side effects of this class of drugs becomes a major focus when caring for HCV patients under treatment. In a previous study using The Center for Epidemiologic Studies Depression Scale (CES-D) to assess depressive symptoms in HCV patients, an item analysis of 113 CES-D questionnaires revealed 'restless sleep' was reported by 88% of the patients after 24 weeks of treatment with INFalpha-2b plus ribavirin. The clinical significance of disturbed sleep lies in the disruptive nature of the symptoms. Disturbed sleep contributes to impaired cognition, altered mood, poor social functioning, and treatment compliance. Methods: Cross sectional study of 2 cohorts of subjects. Self-reporting questionnaire, Sleep Quality Profile (SQP) composed of 8-item dichotomous scale designed to identify limb movement disordered sleep (LMDS) and sleep disordered breathing (SDB). SQP reliability KR-20=0.79. Kruskal-Wallis Test of the equality of medians for two or more populations and analysis of variance (ANOVA) of means were used to analyze SQP responses collectively and individually. Findings: Control subjects had significantly higher total SQP scores then HCV subjects (x=6.7 + 2.4, x=4.5 + 2.1 p=< 01, respectively). However, when diagnostic groups of symptoms were analyzed, the percent of subjects in each cohort (Control subjects and HCV subjects) reporting symptoms of LMDS were similar: Arm or leg movements during sleep 62% and 69%, difficulty sleeping at night 64% and 69%, tired upon awaking 75% and 80%, and waking up with headaches 56% and 58%, respectively. Where as the percent of subjects in each cohort (Control subjects and HCV subjects) reporting symptoms of SDB were significantly different: Told they snore 60% and 9%, stop breathing during sleep 92% and 39%, and waking up gasping or choking 56% and 23%, respectively. Conclusion: Although the statistical differences between Cohort 1 and 2 are significant in relation to symptoms of sleep disorder breathing, the important information identified in this study is that non-cirrhotic HCV patients receiving INF alpha-2b + ribavirin report similar symptoms of limb movement disordered sleep as those control subjects. Further study is needed in HCV patients receiving antivirals using nocturnal polysomnography and biologic sleep markers to ascertain the objective characteristics and possible etiology of the limb movement disordered sleep and to guide treatment strategies for this population. Implications: Disturbed sleep patterns could be a significant modulator in the development of future antiviral therapies. Accurate interpretation of sleep instrument scores depends upon the reliability and validity of the instruments in the study population. It is essential to determine prevalence, incidence, and risk factors associated with this type of sleep disturbance. Reports of these epidemiological aspects are lacking in the literature and are required in order to design intervention trials for disturbed sleep in HCV patients leading development of best intervention strategies.

Repository Posting Date:
26-Oct-2011
Date of Publication:
Jul-2002
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleDisturbed Sleep Patterns in Non-cirrhotic Hepatitis C Patients Receiving Interferon Alpha-2b Plus Ribavirinen_GB
dc.identifier.urihttp://hdl.handle.net/10755/151856-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Disturbed Sleep Patterns in Non-cirrhotic Hepatitis C Patients Receiving Interferon Alpha-2b Plus Ribavirin</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2002</td></tr><tr class="item-conference-date"><td class="label">Conference Date:</td><td class="value">July, 2002</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Clark, Cinda</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of Texas at Houston</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Assistant Professor</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">Cinda.H.Clark@uth.tmc.edu</td></tr><tr><td colspan="2" class="item-abstract">Objective: The study objective was to describe the attributes of disturbed sleep patterns in hepatitis C (HCV) patients and contract these attributes to a control group of patients. Design: Prospective cross-sectional study. Population, Sample, Setting, Years: A convenience sample of 200 subjects from a major metropolitan university affiliated teaching facility was recruited from September 1999 to September 2001. Cohort 1 (control group) included 100 subjects with complaints of difficulty sleeping who were referred for diagnostic sleep studies and had no history of HCV or liver disease. Cohort 2 included 100 subjects with chronic active HCV, compensated liver disease, and no histologic evidence of cirrhosis receiving INF alpha-2b + ribavirin for 24 weeks. Concept and Variable Studied: The current standard therapy for chronic active hepatitis C is interferon plus ribavirin with the primary goal of treatment a sustained elimination of the HCV. The one difficulty in treating patients with hepatitis C is both the relatively low end of treatment response rate associated with interferon monotherapy (10% - 20%) and interferon plus ribavirin combination therapy (47% - 67%) and the side effect profile associated with this class of drugs. Maximizing treatment compliance and minimizing the side effects of this class of drugs becomes a major focus when caring for HCV patients under treatment. In a previous study using The Center for Epidemiologic Studies Depression Scale (CES-D) to assess depressive symptoms in HCV patients, an item analysis of 113 CES-D questionnaires revealed 'restless sleep' was reported by 88% of the patients after 24 weeks of treatment with INFalpha-2b plus ribavirin. The clinical significance of disturbed sleep lies in the disruptive nature of the symptoms. Disturbed sleep contributes to impaired cognition, altered mood, poor social functioning, and treatment compliance. Methods: Cross sectional study of 2 cohorts of subjects. Self-reporting questionnaire, Sleep Quality Profile (SQP) composed of 8-item dichotomous scale designed to identify limb movement disordered sleep (LMDS) and sleep disordered breathing (SDB). SQP reliability KR-20=0.79. Kruskal-Wallis Test of the equality of medians for two or more populations and analysis of variance (ANOVA) of means were used to analyze SQP responses collectively and individually. Findings: Control subjects had significantly higher total SQP scores then HCV subjects (x=6.7 + 2.4, x=4.5 + 2.1 p=&lt; 01, respectively). However, when diagnostic groups of symptoms were analyzed, the percent of subjects in each cohort (Control subjects and HCV subjects) reporting symptoms of LMDS were similar: Arm or leg movements during sleep 62% and 69%, difficulty sleeping at night 64% and 69%, tired upon awaking 75% and 80%, and waking up with headaches 56% and 58%, respectively. Where as the percent of subjects in each cohort (Control subjects and HCV subjects) reporting symptoms of SDB were significantly different: Told they snore 60% and 9%, stop breathing during sleep 92% and 39%, and waking up gasping or choking 56% and 23%, respectively. Conclusion: Although the statistical differences between Cohort 1 and 2 are significant in relation to symptoms of sleep disorder breathing, the important information identified in this study is that non-cirrhotic HCV patients receiving INF alpha-2b + ribavirin report similar symptoms of limb movement disordered sleep as those control subjects. Further study is needed in HCV patients receiving antivirals using nocturnal polysomnography and biologic sleep markers to ascertain the objective characteristics and possible etiology of the limb movement disordered sleep and to guide treatment strategies for this population. Implications: Disturbed sleep patterns could be a significant modulator in the development of future antiviral therapies. Accurate interpretation of sleep instrument scores depends upon the reliability and validity of the instruments in the study population. It is essential to determine prevalence, incidence, and risk factors associated with this type of sleep disturbance. Reports of these epidemiological aspects are lacking in the literature and are required in order to design intervention trials for disturbed sleep in HCV patients leading development of best intervention strategies.<br/><br/></td></tr></table>en_GB
dc.date.available2011-10-26T11:15:58Z-
dc.date.issued2002-07en_GB
dc.date.accessioned2011-10-26T11:15:58Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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