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Possible pathophysiological mechanisms explaining sleep–wake abnormalities in cirrhotic patients
| Clinical features | Pathophysiological mechanisms |
|---|---|
| Delayed sleep onset | Decreased melatonin clearance Delayed melatonin peak Altered circadian variation of core body temperature |
| Excessive daytime sleepiness | Hepatic encephalopathy (HE) |
| Short total sleep time, low sleep efficiency, frequent awakenings | HE Increased interleukin-6 Glucose level fluctuations Low values of ghrelin |
