P133 Severe actigraphy-measured sleep dysfunction is associated with disease severity and poor quality of life in advanced chronic liver disease: UK prospective case-control study

<h3>Background</h3> Prevalence of patient-reported sleep disturbance is high in advanced chronic liver disease (AdvCLD), but objective, home-based evidence is lacking. To effectively treat sleep disturbance in AdvCLD, a thorough understanding of variability (vs other disease populations), predictors and impact of sleep disturbance is needed. Using wrist-worn actigraphy, we aimed to investigate (a) sleep indices in AdvCLD compared to healthy controls (HC) and chronic inflammatory disease (CID; inflammatory bowel or arthritis), (b) predictors of poor sleep and (c) the impact on quality of life (QoL). <h3>Method</h3> Outpatients with AdvCLD awaiting liver transplant, in parallel to age/sex matched CID and HC were recruited from Birmingham, UK. All wore a GENEActiv® wrist accelerometer for 14-days at home. Clinical characteristics, disease severity (UKELD), and quality of life (QoL) (Chronic liver disease questionnaire [CLDQ]) were recorded. Sleep window, sleep onset, the midpoint of sleep, sleep duration (excluding any waking periods during the sleep window) and sleep efficiency were calculated for each valid day and averaged across all valid days. <h3>Results</h3> 44 AdvCLD (63% male, mean age 54, UKELD 52, 50% ArLD), 13 CID (46% male, age 45) and 17 HC (59% male, age 47) participants were recruited. The AdvCLD group had a later sleep onset (mean[standard deviation(SD)] 00:01[1.76] vs 22:56[0.84hrs], p=0.02, 95% CI -2.01 to -0.17hrs) and midpoint (03:55[1.73] vs 03:01[0.81], p= 0.02), shorter sleep duration (5.99hrs[1.34] vs 6.95hrs[0.88], p=0.01, 95% CI 0.23 to 1.68hrs) and lower sleep efficiency (77.8%[7.35] vs 85.4%[9.06], p=&lt;0.001) compared to HC (Fig. 1). Additionally, sleep duration (5.99hrs[1.34] vs 6.95hrs[0.92], p=&lt;0.001 95% CI 2.81 to 11.9hrs) and efficiency (77.8%[7.35] vs 84.8%[6.5], p=0.02 95% CI 0.17 to 1.76%) were significantly less compared to those with CID. Worse sleep efficiency was associated with increased fatigue and reduced emotional function (r=0.37 p=0.02; r=0.37, p= 0.03, respectively). UKELD independently predicted sleep duration (B=-1.58, p=0.02). Longitudinal assessment (n=13) showed liver transplant for AdvCLD improved sleep window and sleep duration (7.2hrs[1.4] vs 8.8hrs[1.9], p=0.003, 95% CI 0.66–2.53hrs; 5.5hrs[0.9] vs 6.9hrs[1.5], p=0.003 95% CI 0.58–2.17hrs, respectively). <h3>Conclusion</h3> Patients with AdvCLD have significantly worse actigraphy-measured sleep disturbances (onset, duration, efficiency) compared to healthy individuals and patients with other chronic inflammatory conditions. Sleep disturbance was independently predicted by disease severity, and negatively associated with QoL measures, but improved with liver transplant. Tailored sleep interventions in AdvCLD are required to enhance patient QoL, with particular focus on those patients with severe disease.