A clinical study on all-night polysomnography in patients with chronic liver failure.

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A study was conducted to elucidate the pattern of impaired sleep, such as a night-day reversal of sleep cycle, often observed in chronic liver failure. Twelve recordings of all-night polysomnography were performed in 8 patients, and the following results were obtained:<BR>1) In 6 patients without encephalopathy at examination, significant reductions in total sleep time (TST), sleep stage 2 and, in particular, REM (rapid eye movement) sleep were observed, while stage W (awaken) was significantly increased when compared with age-matched healthy volunteers. No changes were noted in deep slow wave sleep (SWS), sleep latency and REM latency, and sleep cycle was well preserved.<BR>2) Abnormalities in laboratory data representing elevated blood ammonia level and reduced plasma BCAA/AAA molar ratio were still observed in those patients without hepatic encephalopathy.<BR>3) In one patient who was treated with BCAA granules, decreased REM sleep was found to recover toward normal in parallel with improvement of laboratory data.<BR>These results suggest that abnormal sleep patterns observed in chronic liver failure are reversible by appropriate treatments, and that changes in brain neurotransmitters, including monoamines which are closely related with sleep control, have already occurred at the period free from hepatic encephalopathy.