Abstract：
Sleep disturbances are related to hepatic encephalopathy and hyperammonaemia in patients with cirrhosis. The circadian rhythm is regulated by light stimulation of the retina via melanopsin-containing ganglion cells. The study aimed to investigate whether induced hyperammonaemia affects the pupillary light response and sleep efficiency in patients with cirrhosis.
The study was a single-blinded crossover trial including nine patients with cirrhosis. Sleep was evaluated by Pittsburgh Sleep Quality Index (PSQI) and monitored for twelve nights with wrist accelerometers and sleep diaries. On two experimental days, separated by one week, patients were randomized to ingest either an oral amino acid challenge (AAC) or an isocaloric glucose solution (GS). We measured pupillary light response, capillary ammonia, the Karolinska Sleepiness Scale (KSS), and two neuropsychological tests on both experimental days.
The patients had poor self-assessed sleep quality. The amino acid challenge led to a significant increase in capillary ammonia and KSS. The time spent in bed sleeping after AAC was longer and with a reduced movement index compared to baseline but not different from GS. We found no difference in the pupillary light response or neuropsychiatric tests when comparing the effect of AAC with GS.
Patients with cirrhosis had impaired sleep quality. Induced hyperammonaemia led to increased sleepiness but had no acute effect on pupillary light response or the neuropsychiatric tests.
Registration number: NCT04771104.
The study was a single-blinded crossover trial including nine patients with cirrhosis. Sleep was evaluated by Pittsburgh Sleep Quality Index (PSQI) and monitored for twelve nights with wrist accelerometers and sleep diaries. On two experimental days, separated by one week, patients were randomized to ingest either an oral amino acid challenge (AAC) or an isocaloric glucose solution (GS). We measured pupillary light response, capillary ammonia, the Karolinska Sleepiness Scale (KSS), and two neuropsychological tests on both experimental days.
The patients had poor self-assessed sleep quality. The amino acid challenge led to a significant increase in capillary ammonia and KSS. The time spent in bed sleeping after AAC was longer and with a reduced movement index compared to baseline but not different from GS. We found no difference in the pupillary light response or neuropsychiatric tests when comparing the effect of AAC with GS.
Patients with cirrhosis had impaired sleep quality. Induced hyperammonaemia led to increased sleepiness but had no acute effect on pupillary light response or the neuropsychiatric tests.
Registration number: NCT04771104.
摘要：
肝硬化患者的睡眠障碍与肝性脑病和高氨血症有关。昼夜节律通过包含黑视蛋白的神经节细胞对视网膜的光刺激来调节。该研究旨在研究诱发的高氨血症是否会影响肝硬化患者的瞳孔光反应和睡眠效率。
该研究是一项单盲交叉试验，包括9名肝硬化患者。通过匹兹堡睡眠质量指数（PSQI）评估睡眠，并用手腕加速度计和睡眠日记监测12个晚上。在两个实验日，相隔一周，患者被随机分为口服氨基酸激发(AAC)或等热量葡萄糖溶液(GS).我们测量了瞳孔的光反应,毛细管氨，卡罗林斯卡嗜睡量表(KSS)，和两个实验日的两个神经心理学测试。
患者自我评估的睡眠质量较差。氨基酸挑战导致毛细管氨和KSS的显著增加。与基线相比，AAC后在床上睡觉的时间更长，运动指数降低，但与GS没有差异。当比较AAC与GS的效果时，我们发现瞳孔光反应或神经精神测试没有差异。
肝硬化患者睡眠质量受损。诱导的高氨血症导致嗜睡增加，但对瞳孔光反应或神经精神检查没有急性影响。
注册号：NCT04771104。
该研究是一项单盲交叉试验，包括9名肝硬化患者。通过匹兹堡睡眠质量指数（PSQI）评估睡眠，并用手腕加速度计和睡眠日记监测12个晚上。在两个实验日，相隔一周，患者被随机分为口服氨基酸激发(AAC)或等热量葡萄糖溶液(GS).我们测量了瞳孔的光反应,毛细管氨，卡罗林斯卡嗜睡量表(KSS)，和两个实验日的两个神经心理学测试。
患者自我评估的睡眠质量较差。氨基酸挑战导致毛细管氨和KSS的显著增加。与基线相比，AAC后在床上睡觉的时间更长，运动指数降低，但与GS没有差异。当比较AAC与GS的效果时，我们发现瞳孔光反应或神经精神测试没有差异。
肝硬化患者睡眠质量受损。诱导的高氨血症导致嗜睡增加，但对瞳孔光反应或神经精神检查没有急性影响。
注册号：NCT04771104。
