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• W2061799232 abstract "Bajaj et al1Bajaj J.S. et al.Clin Gastroenterol Hepatol. 2015; 13: 390-397Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar concluded that obstructive sleep apnea (OSA) should be considered in evaluating sleep impairment in cirrhotic patients; in patients with cirrhosis and OSA, psychomotor speed and attention issues are related to cirrhosis, whereas executive function and simulator performance are affected by OSA. In this regard, Helicobacter pylori, as a global environmental agent associated with OSA in some studies,2Stergiopoulos C. et al.Sleep Med. 2012; 13: 212-213Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar, 3Kountouras J. et al.Clin Gastroenterol Hepatol. 2014; 12: 1055-1056Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar might be an underlying denominator involved in some cognitive testing issues and sleep and/or driving disturbances observed in cirrhotic patients. On the basis of histologic analysis for documentation of H pylori infection, we reported an association between H pylori infection and OSA accompanied with increased inflammatory mediator levels, including tumor necrosis factor (TNF)-α, interleukin (IL)1β, ΙL8, and reactive oxygen species (ROS).2Stergiopoulos C. et al.Sleep Med. 2012; 13: 212-213Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar Likewise, other studies showed that increased severity of OSA might be associated with higher H pylori seroprevalence, thereby suggesting the introduction of future relative treatment strategies for the disease. Moreover, H pylori infection is strongly associated with viral-related cirrhosis. H pylori infection is more common in cirrhotic patients with hepatic encephalopathy (HE) than in those without. H pylori infection might be a common denominator associated with cognitive dysfunction–related falls, fractures, or motor vehicle accidents and liver cirrhosis. Higher levels of TNF-α and IL6, also released by H pylori infection, might pose a risk for poorer cognitive dysfunction in these patients, and eradication therapy of H pylori–positive cirrhotic patients might have a beneficial effect on minimal HE.4Kountouras J. et al.Clin Gastroenterol Hepatol. 2011; 9: 624Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar, 5Kountouras J. et al.Hepatology. 2013; 57: 1284Crossref PubMed Scopus (8) Google Scholar An assessed 70 million Americans suffer from some forms of sleep disturbances that cause declined cognitive ability, slower response times, and performance detriments. Communities, including cirrhotic ones, with sleep abnormalities are at greater risk of severe adverse health, economic concerns, and, most seriously, increased all-cause mortality. As in the case of H pylori infection and OSA, inflammatory cytokines such as TNF-α, IL1, and IL6 appear to be significant contributors of sleep disorders.6Ali T. et al.World J Gastroenterol. 2013; 19: 9231-9239Crossref PubMed Scopus (85) Google Scholar H pylori may be implicated in the pathophysiology of HE and post-HE persistent cognitive dysfunction by IL6 and TNF-α, involved through blood-brain barrier disruption in neurodegenerative disorders that can result in long-term neurologic deficits4Kountouras J. et al.Clin Gastroenterol Hepatol. 2011; 9: 624Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar, 5Kountouras J. et al.Hepatology. 2013; 57: 1284Crossref PubMed Scopus (8) Google Scholar; likewise, ROS production by astrocyte swelling appears to be involved in the pathophysiology of HE. ROS-modulated autophagy is associated with HE. We propose that H pylori infection combined with OSA might be involved in the pathophysiology of psychomotor speed and attention issues, executive function, and simulator performance in cirrhotic patients. Therefore, apart from continuous positive airway pressure therapy that improves executive function and simulator performance in patients with OSA, regardless of cirrhosis,1Bajaj J.S. et al.Clin Gastroenterol Hepatol. 2015; 13: 390-397Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar both continuous positive airway pressure and H pylori eradication regimens might also improve cognition, sleep parameters, and/or driving performance in patients with cirrhosis. Because there is a lack of literature showing evidence to support the aforementioned considerations, large-scale studies are warranted to elucidate these fields. Effects of Obstructive Sleep Apnea on Sleep Quality, Cognition, and Driving Performance in Patients With CirrhosisClinical Gastroenterology and HepatologyVol. 13Issue 2PreviewIn patients with cirrhosis, sleep disturbances are assumed to result from hepatic encephalopathy (HE). The effects of obstructive sleep apnea (OSA) on cognition, sleep parameters, or driving in patients with cirrhosis are unclear. Full-Text PDF ReplyClinical Gastroenterology and HepatologyVol. 13Issue 8PreviewWe read with the interest the letter by Kantouros et al1 in response to our article.2 We agree with the authors that the systemic pro-inflammatory milieu can play a strong role in the development and progression of cirrhosis as well as hepatic encephalopathy.3 This could be worsened by concurrent bacterial infections and with gut dysbiosis that is prevalent in these patients.4 However, the relationship of health-related quality of life (HRQOL) with inflammation in cirrhotics without prior hepatic encephalopathy is unclear. Full-Text PDF ReplyClinical Gastroenterology and HepatologyVol. 13Issue 11PreviewWe thank Dr Sargenti and Dr Kalaitzakis for their Letter to the Editor1 in response to our publication.2 They highlighted their data in which they evaluated the risk for community-acquired, health care–associated (HCA), and hospital-acquired (HA) infections in patients with cirrhosis.3 Their retrospective evaluation of 633 patients with cirrhosis over a 10-year period documented no difference in the risk of subsequent infection in all patients regardless of proton pump inhibitor (PPI) use, however, a statistically significant increase in subsequent HCA/HA infections after an index HCA/HA was found in patients prescribed a PPI. Full-Text PDF" @default.
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• W2061799232 title "Helicobacter pylori Associated With Obstructive Sleep Apnea Might Contribute to Sleep, Cognition, and Driving Performance Disturbances in Patients With Cirrhosis" @default.
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