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Abstract
Sleep disturbance and excessive daytime somnolence are common in patients with cirrhosis. In addition, a disturbance of sleep is recognized as one of the early signs of hepatic encephalopathy. Obstructive sleep apnea syndrome (OSAS) was recently reported to be a new complication of liver cirrhosis with ascites, but there few reports evaluating the relationship between the stage of liver cirrhosis and the frequency of sleep apnea or hypopnea. The most common feature of the
sleep pattern in patients with cirrhosis is fragmented nocturnal sleep caused by frequent nocturnal awakenings, and a daytime functioning affected by frequent episodes of undesired sleepiness and more prolonged napping time. In patients with cirrhosis, the diurnal plasma melatonin profile showed a significant delay in both the onset of plasma melatonin increase and in its peak nocturnal level. This displacement of the melatonin profile could be a reflection of an alteration in the phase of the circadian clock. The ascites induced diaphragmatic elevation can produce a decrease in functional residual capacity, and this can induce oxygen desaturation because of ventilation perfusion mismatch. However we think that it is less probable that the enlarged abdominal perimeter can modify by an unknown mechanism, the upper air way system we think that it is more probable that the possible edema of the pharyngeal and laryngeal soft tissues in this patients could increase the collapsibility of the upper airway, thus facilitating the appearance of obstructive sleep apnea.