September 16, 2014
2 min read

Sleep apnea impaired cognition, driving simulation in patients with cirrhosis

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Obstructive sleep apnea in patients with cirrhosis negatively impacted their cognition, sleep and driving simulation habits, according to new study data.

Jasmohan S. Bajaj, MD, division of gastroenterology, hepatology and nutrition, Virginia Commonwealth University and McGuire VA Medical Center, and colleagues conducted a prospective study of liver clinic patients (n=118) between November 2012 and June 2014. Patients were divided into those with: obstructive sleep apnea (OSA) and cirrhosis (n=34); only cirrhosis (n=30); only OSA (n=29); and those without OSA or cirrhosis (controls, n=25). All patients underwent cognitive testing, a sleep assessment and driving simulation test. Driving was tested using a monotonous hour-long simulation in which OSA patients were expected to sleep and therefore have more lane deviations and less speeding events, Bajaj told

"This is because an individual needs to be awake to speed and lane deviations occur more when they are sleepy," Bajaj said.

In addition, researchers tested 10 patients with OSA and cirrhosis and seven OSA patients without cirrhosis before and after continuous positive airway pressure (CPAP) therapy. No OSA patients were receiving CPAP therapy at study initiation.

Jasmohan Bajaj

Jasmohan S. Bajaj

Daytime sleepiness and sleep quality were worse among OSA patients vs. those with just cirrhosis or controls. Nighttime sleep quality also was best in controls vs. non-OSA patients with cirrhosis and both OSA groups. Cognitive performance and proportion impaired on paper-pencil tests was worse among cirrhotic patients compared with noncirrhotic patients.

Driving simulation results showed that speeding events were lower among patients with cirrhosis and OSA compared with the other groups. Lane deviations were greater in the second half of the simulation in both OSA groups compared with non-OSA patients with cirrhosis and controls. Daytime sleepiness positively correlated with total lane deviations (P=.03) and the change in lane deviations (P<.0001) and negatively correlated with total speeding instances (P=.05).

There Apnea-hypopnea index was reduced among the cirrhotic and noncirrhotic patients who underwent CPAP therapy (P=.001 for both). Improvements in the Pittsburgh Sleep Quality Index also were observed among both groups, in addition to improvements in post-simulator sleepiness and executive function. Lane deviations reduced over time in patients after CPAP therapy compared with pre-CPAP therapy.

“Given the burgeoning obesity epidemic, obstructive sleep apnea should be considered in the differential diagnosis of hepatic encephalopathy in cirrhotic outpatients who complain of sleep issues,” Bajaj told “Obstructive sleep apnea can affect cognitive function, driving simulator performance and sleep quality even in the background of cirrhosis. Therefore adequate awareness on the part of the clinician is needed for appropriate diagnosis and therapy for this condition.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.