Fatigue, weakness, and sleep disturbances in liver disease: Diagnosis and patient management

Abstract

Fatigue/weakness in chronic liver diseases is a clinically significant symptom that goes beyond subjective discomfort and requires separate clinical assessment. Available data indicate that fatigue/weakness affects quality of life, daily activities, and prognosis, while more pronounced fatigue/weakness at baseline is independently associated with a higher risk of adverse clinical events in patients with liver fibrosis and cirrhosis. The relevance of this problem is determined by the high prevalence of the symptom, its multifactorial nature, its frequent combination with sleep disorders, depressive symptoms, and reduced physical activity, as well as the need for an interdisciplinary approach to the management of such patients in real clinical practice. The present manuscript is a descriptive review. Literature selection was carried out taking into account scientific significance, relevance, and correspondence to the topic of the review. The review included 62 publications for the period 1977–2026, including clinical guidelines, position papers, reviews, meta-analyses, and clinical studies. The authors consider terminological aspects, the clinical significance of fatigue/weakness, as well as approaches to its diagnosis and treatment. The algorithm for assessing and managing patients with fatigue/weakness is considered in detail and may serve as a roadmap for clinical actions for practicing physicians. Particular attention is paid to sleep disorders and depressive disorders in liver diseases, since these conditions may exacerbate fatigue/weakness, affect quality of life, and reduce adherence to treatment. The role of ademethionine is also highlighted, as it occupies a unique position in the treatment of fatigue/weakness in liver diseases owing to its pleiotropic action.