Sleep disorders are not only common in primary biliary cholangitis (PBC) but signal that the disease is more severe, according to a recent study published in the journal Annals of Hepatology.
“Recognition of sleep complaints may help identify patients with a greater disease burden,” the study’s authors said.
Though PBC has long been tied to sleep problems and fatigue, the exact relationship between poor sleep and health in PBC hasn’t been well researched. The study’s authors wanted to find out how many people with PBC struggle with sleep, and whether those sleep problems were connected to other symptoms and health outcomes. To investigate, they studied 104 adults with PBC who were part of a health registry at a Boston hospital between 2018 and 2024. Most were women, and the average age was 59.
Out of the 104 patients, about one-third reported sleep problems. This is slightly lower than the rate of sleep problems among PBC patients recorded in earlier studies done in China, which ranged from 51% to 58%.
Sign up here to get the latest news, perspectives, and information about PBC sent directly to your inbox. Registration is free and only takes a minute.
In the new study, PBC patients with sleep problems tended to have higher levels of disease activity. Two enzymes used to measure liver function — alkaline phosphatase (ALP) and aspartate aminotransferase (AST) — were higher compared to those of people without sleep problems, indicating more liver damage was happening in the patients with sleep problems.
Those with sleep problems were far less likely to respond well to the standard drug treatment, ursodeoxycholic acid (UDCA). Only 44% met a key treatment goal, compared with 94% of the patients without sleep problems.
Patients with sleep problems also reported more fatigue and more itching, and they rated their own health as poorer.
Read more about PBC signs and symptoms
“These findings emphasize that sleep complaints are an important component of the symptom burden associated with PBC and should not be overlooked in routine care,” the researchers said.
Although the study found that sleep problems tend to occur together with higher liver enzymes, poorer treatment response and more fatigue, the study’s authors cautioned that they can’t say which causes which. “Further studies are needed to clarify the relationship between sleep disturbances, disease activity, and clinical outcomes in PBC,” they concluded.
Hear from a patient with PBC fatigue: “The reality of chronic fatigue and PBC”
