Sleep Quality and Its Associated Factors in Patients With Chronic Hepatitis C Receiving Antiviral Therapy

Purpose: The population with chronic hepatitis C is gradually increasing in the world. The treatment with pegylated Interferon and Ribavirin is still a standard therapy for chronic hepatitis C. Sleep disturbance is a persistent and enduring complaint by patients with chronic hepatitis C during their antiviral therapy. The purpose of this presentation is to explore the sleep quality and its associated factors in patients with chronic hepatitis C receiving antiviral therapy.

Methods: This research was designed as a prospective longitudinal study. The questionnaire of Pittsburg sleep quality index (PSQI) was used to measure the patient’s sleeping quality. The PSQI was developed to assess individual sleep quality and disturbances over 1-month time interval. The 19 self-rated items contain seven dimensions on a 0-3 scale, including subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The higher scores indicate worse sleep quality. Multiple awakenings during the night, sleeping fewer hours than normal, trouble getting back to sleep, trouble falling asleep (sleep latency), and daytime dysfunction. The participants’ demographic data and sleeping scores were collected before initiating antiviral therapy, and thereafter once per month until the therapy completed.

Participants: The inclusion criteria of this study were: (1) The patients’ serum tests with Anti-HCV (+) lasted for more than 6 months; and (2) The patients with hepatitis C is currently treated with pegylated Interferon and/or Ribavirin. The exclusion criteria were: (1) The patients under age 18; (2) Co-infected with HIV; (3) The patients with substance abuse and/or alcoholism; and (4) The individuals have hypo-thyroidism or hyper-thyroidism from past medical history.

Results:  Twenty four patients with chronic hepatitis C were recruited in this study, including 6 females (25%) and 18 males (75%). The average age of the participants was 55 years (range, 35 to 74 years). The t-test revealed there was no significant difference between males and females in sleep quality.

The total mean score of sleep quality was 8.09 (SD= 4.76). The mean scores for each dimension of sleep quality were following: subjective sleep quality (mean= 1.49, SD= 0.92), sleep latency (mean= 1.61, SD= 1.17), sleep duration (mean= 0.79, SD= 1.03), habitual sleep efficiency (mean= 1.06, SD= 1.33), sleep disturbances (mean= 1.30, SD= 0.50), use of sleeping medication (mean= 1.27, SD= 1.38), and daytime dysfunction (mean= 0.65, SD= 0.76), respectively.

Conclusion:  Poor sleep quality is one of the most frequent and intense adverse effect experienced by the patients with hepatitis C while receiving antiviral therapy. Multiple awakenings during the night, sleeping fewer hours than normal, trouble getting back to sleep, trouble falling asleep (sleep latency), and daytime dysfunction often occurred in these patients.