Sleep disturbances in newly diagnosed treatment-naïve patients with Wilson's disease

Most neurodegenerative and chronic liver disorders are associated with sleep disturbances (SD). SD may be expected to occur in patients with Wilson's disease (WD), an inherited disorder of copper metabolism that mostly affects the liver and brain; however, there is a lack of observations, particularly in treatment-naïve WD patients.

We evaluated SD in 19 newly diagnosed treatment-naïve WD patients. All patients completed the Beck Depression Inventory (BDI), the Athens Insomnia Scale (AIS) and the Epworth Sleepiness Scale (ESS), and underwent nightlong video polysomnography (vPSG). Results of vPSG in WD patients were compared with results from 19 sex- and age-matched healthy controls.

Depressive symptoms were not reported by patients on routine examination although three patients were diagnosed with mild depression. No patients reported SD during routine examination; three patients had insomnia according to the AIS and all patients scored 0 on the ESS. Despite the lack of reporting of SD by patients, significant differences were observed between WD patients and controls following vPSG analysis: WD patients had shorter mean total sleeping time (366.2 vs. 451.7 min), a lower percentage of rapid-eye movement (15.4 vs. 20.6%), longer sleep latency (36.7 vs. 10.4 min) and lower sleep efficiency (76.2 vs. 93.8%) (all P ≤ 0.01). SD tended to be worse in patients with neurological WD compared with hepatic WD.

As SD may precede depression and severely affect quality of life, our findings suggest that patients with WD should be screened for SD with suitable methods.