Patients with chronic hepatitis C, even without cirrhosis, were more likely to experience altered sleep patterns — including insomnia, fatigue, depression and a reduced quality of life — compared with healthy controls, study findings indicate.

“The reported results suggest and confirm previous observations that sleep disruption and its consequences should be regarded as an extra hepatic manifestation of chronic hepatitis C,” Daniel Shouval, MD, director of the liver unit at Hadassah-Hebrew University Hospital in Ein-Kerem, Jerusalem, reported in the Journal of Hepatology.

Insomnia, fatigue, depression and cognitive impairment are common symptoms in patients with chronic liver disease with cirrhosis. However, abnormal sleep patterns have also been documented in patients with cirrhosis in the absence of overt hepatic encephalopathy, as well as in patients with chronic liver disease without cirrhosis, according to background information provided in the study.

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To better characterize the sleep disturbances in hepatitis C virus-infected patients, Karin Weissenborn, MD, of Hannover Medical School in Hannover Germany and colleagues examined data from 20 anti-HCV positive, genotype 1b women with a mean age of 56.8 years diagnosed in the previous 30 years, and 19 age-matched healthy women with a mean age of 55.3 years. Overall, 12 of the 20 patients with a previous HCV diagnosis were still HCV-RNA positive on polymerase chain reaction assay.

All study participants were asked to fill out various questionnaires, keep a “sleep diary” and use an actigraph (a wrist worn device for monitoring of motor activity over a period of 24 hours for five days). Abnormalities in sleep patterns were present in both the 12 viremic patients and seven HCV RNA-negative patients.

Patients with a history of chronic HCV without cirrhosis were more likely to develop a disrupted circadian rhythm vs. healthy controls, the researchers found. They also had higher scores for depression, fatigue and lower quality of life scores than the healthy controls. Fatigue and quality of life scores correlated with bad sleep quality and daytime sleepiness.

Although patients with hepatitis C displayed increased nocturnal activity, no correlation could be established between fatigue and sleep pattern abnormality and 24-hour activity level.  

“[T]he discussed report provides descriptive evidence that a history of past or present mild chronic hepatitis C virus infection even without clinical evidence for cirrhosis or ‘traditional’ hepatic encephalopathy is associated with an altered sleep pattern, which has a negative impact on quality of life and well being,” Shouval concluded.


  1. Heeren M. J Hepatology. 2013; doi: 10.1016/j.jhep.2013.11.030.
  2. Shouval D. J Hepatology. 2014;doi:

Disclosure: The researchers report no relevant financial disclosures.