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Liver Cirrhosis and Circadian Rhythm
- Petra Steindl, MD;
- Phyllis Zee, MD, PhD; and
- Andres T. Blei, MD
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IN RESPONSE:
Drs. Garfinkel and Zisapel suggest that wrist actigraphy is superior to sleep diaries as a method to monitor sleep in patients with cirrhosis. Our preliminary studies indicate that this tool may be of value for such patients [1], but caution is warranted before this new technology is embraced. Measurement of wrist activity during polysomnography has not yet been validated for cirrhotic patients, and results may differ from those seen in other populations [2]. Furthermore, we would rather not be hasty in dismissing the role of sleep diaries. They reflect a subjective symptom, which is in essence what the physician is attempting to address.
We postulated two explanations for our results, but Garfinkel and Zisapel advocate only one. We find their reasoning to be erroneous. The demonstration of decreased 6-sulphatoxymelatonin levels would confirm what is already known: that the hepatic clearance of melatonin is reduced in patients with cirrhosis [3]. This finding does not, however, indicate whether the elevated melatonin levels observed in the morning hours are phase shifting the endogenous “biological clock.” Additional studies are needed to examine other biological rhythms and to assess the ability of other stimuli to produce phase shifts.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
