Sleep disorders in hepatocellular carcinoma

Table 1 Impacts of different types of sleep disorders on liver cancer

Ref.	Country	Type of sleep disorders	Type of cancer	Outcomes
[13]	United Kingdom	Insomnia	HCC	HR: 1.46, 95%CI: 1.15-1.85
[14]	United States	Insomnia	HCC	HR: 2.00, 95%CI: 1.22-3.26
		Long sleep durations	HCC	HR: 1.63, 95%CI: 1.04-2.65
		Daytime napping	HCC	HR: 1.46, 95%CI: 1.04-2.06
[4]	China	Obstructive sleep apnea	Liver cancer	RR: 1.19, 95%CI: 1.10-1.29
[26]	United States	Circadian rhythm disruption	HCC	IRR: 1.07; 95%CI: 1.01-1.14

Summary of epidemiological studies investigating associations between specific sleep disorders and liver cancer risk, categorized by disorder type, geographic region, and reported effect measures (hazard ratios, relative risks, or incidence rate ratios with 95%CI): Insomnia, prolonged sleep duration, daytime napping, obstructive sleep apnea and circadian rhythm disruption increase the risk of liver cancer. HR: Hazard ratio; RR: Relative risk; IRR: Incidence rate ratio; HCC: Hepatocellular carcinoma.

Table 2 Comparison of common sleep disorders medications

Ref.	Category	Advantages	Limitations	Target population
[102,103]	Non-benzodiazepines	Rapid onset, lower risk of dependence, minimal next-day residual effects	No anxiolytic efficacy; sleepwalking risk	Short-term insomnia, elderly patients
[99-101]	Benzodiazepines	Potent anxiolytic effects; well-established efficacy	High dependence risk; cognitive impairment; fall risk	Anxiety-related insomnia (short-term use)
[106,107]	Melatonin receptor agonists	No dependence risk; favorable safety	Limited efficacy in primary insomnia	Circadian rhythm disorders; comorbid respiratory conditions
[104,105]	Antidepressants	Effective for mood-related insomnia	Diverse side effects (e.g., weight gain, hypotension)	Chronic insomnia with depression/anxiety
[108,109]	Orexin receptor antagonists	Novel mechanism; fewer adverse effects	Limited long-term efficacy data	Treatment-resistant insomnia; patients requiring prolonged therapy

Key characteristics of common insomnia medications are summarized, including: Non-benzodiazepines: Rapid onset with lower risk of dependence but limited anxiolytic effects. Benzodiazepines: Potent anxiolytic effects yet high dependence risk. Melatonin receptor agonists: No dependence risk yet limited efficacy in primary insomnia. Antidepressants: Preferred for comorbid mood disorders despite side effects. Orexin receptor antagonists: Novel mechanism and fewer adverse effects (long-term safety pending).