1028 SEVERE PERIODIC LIMB MOVEMENTS IN PATIENTS WITH CIRRHOSIS OF THE LIVER PERIODIC LIMB MOVEMENTS IN PATIENTS WITH CIRRHOSIS OF THE LIVER

Abstract

Introduction: Questionnaires indicate that patients with liver disease have disturbed sleep. However, polysomnographic studies to quantify sleep architecture and sleep disorders in this population is lacking. In this study we compared polysomnographic findings of two groups of patients with clinically stable but severe end stage pathology of liver and heart. Method(s): This was a prospective study of consecutive patients with end-stage liver disease, or severe heart failure. Patients underwent full night attended polysomnography along with a number of tests including pulmonary function tests, cardiac nuclear study to measure left ventricular function, complete blood counts. liver and renal function tests and iron studies. All patients were part of prospective studies supported by Veterans Administration grants. All patients with cirrhosis had undergone serial random tests for blood ethanol. Thirty eight consecutive patients without sleep-related disordered breathing were enrolled. Thirty seven patients are the subject of this study,13 patients with cirrhosis and 24 with heart failure. One patient with cirrhosis who tested positive for blood ethanol was excluded. Polysomnograms were scored blindly by one author. Result(s): Compared to patients with heart failure, patients with cirrhosis suffered from severe periodic limb movements during sleep with an index of 39 per hour of sleep. associated with excessive arousals. In patients with cirrhosis, serum iron and ferritin levels were either upper normal limit or elevated. There were significant correlations between severity of periodic limb movements versus blood levels of bilirubin (r= 0.73, p=0.004) and ammonia (r=0.74, p=.017). Conclusion(s): This is the first polysomnographic study of patients with stable cirrhosis demonstrating severe periodic limb movements with excessive arousals. Severity of periodic limb movements correlated with blood levels of bilirubin and ammonia which are neurotoxic. The pathobiochemical relevance remains to be established. Since a subset of patients with cirrhosis acquires a syndrome similar to idiopathic Parkinson's disease which per se is frequently associated with periodic limb movements, our results are consistent with this notion. Future studies are needed to determine if periodic limb movements of cirrhosis is an early indication of incident parkinsonian syndrome and if early treatment with dopamine agonists may have an impact.