Sleep disorders in primary biliary cholangitis: A prospective analysis of clinical and patient-reported outcomes

Primary biliary cholangitis (PBC) is associated with impaired quality of life and symptoms such as fatigue, pruritus, and sleep disturbances. However, the relationship between sleep disorders, disease severity, and patient outcomes is not well understood. This study evaluated the prevalence of sleep disorders in patients with PBC and their association with symptoms and clinical outcomes.

Adult patients with PBC enrolled in a prospective autoimmune liver disease registry between 2018 and 2024 were included. Sleep disturbances, fatigue, pruritus, and self-rated health were assessed using the PBC-40 and Chronic Liver Disease Questionnaire (CLDQ). Clinical characteristics, laboratory values, and treatment response were compared between patients with and without sleep disorders. Logistic regression was used to identify factors associated with sleep disturbances.

Among 104 patients with PBC, 33% reported sleep disorders. Patients with sleep disorders had higher ALP (p = 0.003) and AST levels (p = 0.018), reported more fatigue (p = 0.016), and had poorer self-rated health (p < 0.001). They were also less likely to meet Paris II response criteria (44%vs. 94%, p < 0.001). In multivariable analysis, higher ALP levels, non-response to UDCA, and poorer self-rated health were independently associated with sleep disorders.

Sleep disorders are prevalent among patients with PBC and are associated with greater symptom burden, lower rates of response to UDCA, and poorer self-rated health. Recognition of sleep complaints may help identify patients with a greater disease burden.