{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T10:47:11Z","timestamp":1784544431341,"version":"3.55.0"},"reference-count":38,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,3,26]],"date-time":"2022-03-26T00:00:00Z","timestamp":1648252800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Introduction\/Aim. The aim of this study was to assess the prevalence of cognitive impairments and their association with sleep patterns in a cohort of patients diagnosed with chronic liver disease (CLD). Material and methods. The present paper is a prospective cohort study, carried out over a period of 12 months, among patients with various stages of CLD. We evaluated the cognitive function through psychometric hepatic encephalopathy score (PHES), while sleep was assessed by actigraphy and two self-reported questionnaires: Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). Results. Seventy-four patients with CLD were considered eligible and were enrolled between December 2020\u2013November 2021. The prevalence of minimal hepatic encephalopathy (MHE) in the entire cohort was 41.9%, and the diagnosis was considered for PHES scores \u2264 \u22123. Patients with cirrhosis recorded significantly lower PHES scores compared to patients with other CLDs but without cirrhosis (\u22123.19 \u00b1 3.89 vs. 0.19 \u00b1 2.92, p &lt; 0.05). Patients who exhibited MHE suffered from poor sleep, daytime somnolence, disturbed nighttime sleep, and low overall sleep efficacy. Patients diagnosed with MHE and undergoing treatment with lactulose and\/or rifaximin for prevention of overt hepatic encephalopathy (HE) showed better results in terms of sleep parameters compared to patients diagnosed with MHE but without treatment. Conclusions. This research increases awareness regarding the connection between sleep features and MHE in patients with cirrhosis and other CLDs. A deeper insight into the subclinical stages of HE and associated sleep disturbances is warranted in future studies.<\/jats:p>","DOI":"10.3390\/brainsci12040444","type":"journal-article","created":{"date-parts":[[2022,3,27]],"date-time":"2022-03-27T21:27:51Z","timestamp":1648416471000},"page":"444","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["The Prevalence and Association of Cognitive Impairment with Sleep Disturbances in Patients with Chronic Liver Disease"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5730-9381","authenticated-orcid":false,"given":"Oana-Mihaela","family":"Plotogea","sequence":"first","affiliation":[{"name":"Department 5, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Gastroenterology, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6837-260X","authenticated-orcid":false,"given":"Camelia Cristina","family":"Diaconu","sequence":"additional","affiliation":[{"name":"Department 5, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gina","family":"Gheorghe","sequence":"additional","affiliation":[{"name":"Department 5, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Gastroenterology, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madalina","family":"Stan-Ilie","sequence":"additional","affiliation":[{"name":"Department 5, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Gastroenterology, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mircea-Alexandru","family":"Badea","sequence":"additional","affiliation":[{"name":"\u201cSf. Ioan Cel Nou\u201d Emergency County Hospital, 720224 Suceava, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina Cijevschi","family":"Prelipcean","sequence":"additional","affiliation":[{"name":"Department of Medical Specialties (I), Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5382-4765","authenticated-orcid":false,"given":"Gabriel","family":"Constantinescu","sequence":"additional","affiliation":[{"name":"Department 5, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Gastroenterology, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2650","DOI":"10.1016\/j.cgh.2019.07.060","article-title":"Contemporary Epidemiology of Chronic Liver Disease and Cirrhosis","volume":"18","author":"Moon","year":"2020","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1016\/S0140-6736(18)32279-7","article-title":"Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990\u20132017: A systematic analysis for the Global Burden of Disease Study 2017","volume":"392","author":"James","year":"2018","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2647","DOI":"10.1097\/CM9.0000000000001084","article-title":"Management of chronic liver diseases and cirrhosis: Current status and future directions","volume":"133","author":"Xu","year":"2020","journal-title":"Chin. Med. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S46","DOI":"10.1016\/S0168-8278(12)60006-3","article-title":"Managing systemic symptoms in chronic liver disease","volume":"56","author":"Newton","year":"2012","journal-title":"J. Hepatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"39","DOI":"10.11124\/jbisrir-2015-1987","article-title":"Impact of physical and psychological factors on health-related quality of life in adult patients with liver cirrhosis: A systematic review protocol","volume":"13","author":"Polis","year":"2015","journal-title":"JBI Database Syst. Rev. Implement. Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1002\/hep.27210","article-title":"Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver","volume":"60","author":"Vilstrup","year":"2014","journal-title":"Hepatology."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1526","DOI":"10.1016\/j.jhep.2020.07.013","article-title":"Hepatic encephalopathy: Novel insights into classification, pathophysiology and therapy","volume":"73","author":"Rose","year":"2020","journal-title":"J. Hepatol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"American Association for the Study of Liver Diseases, and European Association for the Study of the Liver (2014). Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases. J. Hepatol., 61, 642\u2013659.","DOI":"10.1016\/j.jhep.2014.05.042"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Gim\u00e9nez-Garz\u00f3, C., Fiorillo, A., Ballester-Ferr\u00e9, M.P., Gallego, J.-J., Casanova-Ferrer, F., Urios, A., Benlloch, S., Mart\u00ed-Aguado, D., San-Miguel, T., and Tosca, J. (2021). A New Score Unveils a High Prevalence of Mild Cognitive Impairment in Patients with Nonalcoholic Fatty Liver Disease. J. Clin. Med., 10.","DOI":"10.3390\/jcm10132806"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Thomsen, K.L., Macnaughtan, J., Tritto, G., Mookerjee, R.P., and Jalan, R. (2016). Clinical and Pathophysiological Characteristics of Cirrhotic Patients with Grade 1 and Minimal Hepatic Encephalopathy. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0146076"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"5446","DOI":"10.3748\/wjg.v24.i48.5446","article-title":"Quality of life in patients with minimal hepatic encephalopathy","volume":"24","author":"Ridola","year":"2018","journal-title":"World J. Gastroenterol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Plotogea, O.M., Gheorghe, G., Stan-Ilie, M., Constantinescu, G., Bacalbasa, N., Bungau, S., and Diaconu, C.C. (2021). Assessment of Sleep among Patients with Chronic Liver Disease: Association with Quality of Life. J. Pers. Med., 11.","DOI":"10.3390\/jpm11121387"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1016\/j.jhep.2014.06.034","article-title":"Health related quality of life in people with advanced chronic liver disease","volume":"61","author":"Orr","year":"2014","journal-title":"J. Hepatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.1016\/j.cgh.2017.01.027","article-title":"Most Individuals With Advanced Cirrhosis Have Sleep Disturbances, Which Are Associated With Poor Quality of Life","volume":"15","author":"Ghabril","year":"2017","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1007\/s10072-008-0973-7","article-title":"Sleep disturbance and daytime sleepiness in patients with cirrhosis: A case control study","volume":"29","author":"Mostacci","year":"2008","journal-title":"Neurol. Sci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1111\/j.1478-3231.2009.02089.x","article-title":"Night-time sleep disturbance does not correlate with neuropsychiatric impairment in patients with cirrhosis","volume":"29","author":"Montagnese","year":"2009","journal-title":"Liver Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/0165-1781(89)90047-4","article-title":"The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research","volume":"28","author":"Buysse","year":"1989","journal-title":"Psychiatry Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1093\/sleep\/14.6.540","article-title":"A New Method for Measuring Daytime Sleepiness: The Epworth Sleepiness Scale","volume":"14","author":"Johns","year":"1991","journal-title":"Sleep"},{"key":"ref_19","unstructured":"(2022, February 06). Available online: https:\/\/mapi-trust.org\/."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1007\/s11901-018-0390-1","article-title":"Assessment and Management of Sleep Disturbance in Cirrhosis","volume":"17","author":"Formentin","year":"2018","journal-title":"Curr. Hepatol. Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s40265-018-1018-z","article-title":"Hepatic Encephalopathy: Definition, Clinical Grading and Diagnostic Principles","volume":"79","author":"Weissenborn","year":"2019","journal-title":"Drugs"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.1007\/s11011-016-9878-y","article-title":"Diagnosis of minimal hepatic encephalopathy in a tertiary care center from eastern Romania: Validation of the psychometric hepatic encephalopathy score (PHES)","volume":"31","author":"Badea","year":"2016","journal-title":"Metab. Brain Dis."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"World Medical Association (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research in-volving human subjects. JAMA, 310, 2191\u20132194.","DOI":"10.1001\/jama.2013.281053"},{"key":"ref_24","first-page":"959","article-title":"Baveno VII Faculty. Baveno VII-Renewing consensus in portal hypertension","volume":"76","author":"Bosch","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1016\/S0168-8278(01)00026-5","article-title":"Neuropsychological characterization of hepatic encephalopathy","volume":"34","author":"Weissenborn","year":"2001","journal-title":"J. Hepatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1157\/13091264","article-title":"Tablas de normalidad de la poblacion espanola para los tests psicometricos utilizados en el diagnostico de la encefalopatia hepatica minima [Normality tables in the Spanish population for psychometric tests used in the diagnosis of minimal hepatic encephalopathy]","volume":"127","author":"Cordoba","year":"2006","journal-title":"Med. Clin."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"421","DOI":"10.4103\/1119-3077.204375","article-title":"Normalization of the psychometric hepatic encephalopathy score for diagnosis of minimal hepatic encephalopathy in Turkey","volume":"20","author":"Coskun","year":"2017","journal-title":"Niger. J. Clin. Pract."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1016\/j.jhep.2008.04.022","article-title":"Detection of minimal hepatic encephalopathy: Normalization and optimization of the Psychometric Hepatic Encephalopathy Score. A neuropsychological and quantified EEG study","volume":"49","author":"Amodio","year":"2008","journal-title":"J. Hepatol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1038\/ajg.2015.377","article-title":"Diagnosis of Minimal Hepatic Encephalopathy Using Stroop EncephalApp: A Multicenter US-Based, Norm-Based Study","volume":"111","author":"Allampati","year":"2016","journal-title":"Am. J. Gastroenterol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Coubard, O.A., Ober, K.M., Gaumet, M., Urbanski, M., Amato, J.N., Chapron, V., Weiss, N., Kinugawa, K., Weissenborn, K., and Thabut, D. (2021). Standardization of the psychometric hepatic encephalopathy score in a French population. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0257136"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1007\/s11011-015-9688-7","article-title":"Minimal hepatic encephalopathy characterized by parallel use of the continuous reaction time and portosystemic encephalopathy tests","volume":"30","author":"Lauridsen","year":"2015","journal-title":"Metab. Brain Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"S40","DOI":"10.1016\/S1665-2681(19)31605-9","article-title":"Prevalence of minimal hepatic encephalopathy in cirrhotic patients","volume":"10","year":"2011","journal-title":"Ann. Hepatol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.jceh.2018.08.010","article-title":"Minimal\/Covert Hepatic Encephalopathy-Impact of Comorbid Conditions","volume":"9","author":"Weissenborn","year":"2019","journal-title":"J. Clin. Exp. Hepatol."},{"key":"ref_34","first-page":"454","article-title":"Portal-systemic encephalopathy; neurological complications of liver disease","volume":"267","author":"SHERLOCK","year":"1954","journal-title":"Lancet"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Plotogea, O.-M., Ilie, M., Bungau, S., Chiotoroiu, A., Stanescu, A., and Diaconu, C. (2021). Comprehensive Overview of Sleep Disorders in Patients with Chronic Liver Disease. Brain Sci., 11.","DOI":"10.3390\/brainsci11020142"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"S248","DOI":"10.21037\/jtd-cus-2020-012","article-title":"Sleep disorder in patients with chronic liver disease: A narrative review","volume":"12","author":"Shah","year":"2020","journal-title":"J. Thorac. Dis."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1007\/s11011-016-9944-5","article-title":"Sleep disturbances in patients of liver cirrhosis with minimal hepatic encephalopathy before and after lactulose therapy","volume":"32","author":"Singh","year":"2017","journal-title":"Metab. Brain Dis."},{"key":"ref_38","first-page":"21541","article-title":"Changes in sleep architecture and quality in minimal hepatic encephalopathy patients and relationship to psychological dysfunction","volume":"8","author":"Liu","year":"2015","journal-title":"Int. J. Clin. Exp. Med."}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/12\/4\/444\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:44:03Z","timestamp":1760136243000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/12\/4\/444"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,26]]},"references-count":38,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["brainsci12040444"],"URL":"https:\/\/doi.org\/10.3390\/brainsci12040444","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,26]]}}}