Fatigue and Sleep Quality before and after Liver Transplantation

Abstract

Context Recent publications suggest that fatigue and sleep disturbance are problems in patients with chronic liver disease and in liver transplant recipients. Objectives To characterize the severity and nature of fatigue and sleep quality before and after liver transplantation, to examine the relationship between fatigue/sleep quality and quality of life, and to identify their multivariate correlates. Design, Settings, and Participants Cross-sectional survey administered to 110 patients before and 95 patients after liver transplantation at 2 transplant centers. Main Outcome Measures Fatigue and sleep quality. Results Most pretransplant (86%) and posttransplant (76%) patients experienced high fatigue severity. Correlates of pretransplant fatigue severity were being female (odds ratio [OR] = 0.22, P= .04), higher body mass index (OR = 1.07, P= .04), higher mood disturbance (OR=1.05, P= .02), and poor sleep quality (OR=0.26, P= .02). Correlates of posttransplant fatigue severity were use of sleep medications in the past month (OR = 0.51, P= .02) and higher mood disturbance (OR = 1.06, P = .004). Seventy-three percent of pretransplant and 77% of posttransplant patients were classified as having poor sleep quality. Higher body mass index (OR = 1.06, P= .05), sleep medications (OR=0.43, P= .03), and more mood disturbance (OR=1.04, P = .007) were predictive of poor sleep quality in pretransplant patients, whereas higher body mass index (OR=1.07, P= .04) and more anxious mood (OR=1.28, P = .03) were predictive of poor sleep quality in posttransplant patients. Conclusion A very high proportion of both pretransplant and posttransplant patients experience clinically severe fatigue levels. Prospective research is necessary to identify causal mechanisms of these disorders and to evaluate strategies to reduce fatigue severity and improve sleep quality.