Association between non-alcoholic fatty liver disease and obstructive sleep apnea

Umbro, I.; Fabiani, Valerio; Fabiani, Marco; Angelico, Francesco; Ben, Maria Del

doi:10.3748/wjg.v26.i20.2669

Cited by 42 publications

(32 citation statements)

References 52 publications

(46 reference statements)

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“…[ 1 ] The chronic intermittent nocturnal hypoxia resulting from repeated upper airway obstruction in OSA patients is considered to be a contributing factor in the development of NAFLD. [ 2 ] The general population prevalence estimates for OSA vary from 9.3% in India[ 3 ] to that of around 24% and 9% in male and females, respectively, from USA. [ 4 ] For ≥5 AHI events, the overall population prevalence is estimated to vary from 9% to 38%.…”

Section: Introductionmentioning

confidence: 99%

“…[ 5 ] NAFLD is an emerging liver disease and currently the most common cause of incidental abnormal liver tests. [ 2 ] The worldwide prevalence of NAFLD is estimated to be around 25% in general population and in up to 75% in obese individuals. [ 6 7 ] In patients undergoing bariatric surgery and having OSA, NAFLD is present in around 80% of cases and vice versa.…”

Section: Introductionmentioning

confidence: 99%

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Association of Obstructive Sleep Apnea with Nocturnal Hypoxemia in Metabolic-Associated Fatty Liver Disease Patients

Tomar

Bhardwaj

Choudhary

et al. 2021

Journal of Family Medicine and Primary Care

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Rationale: Obstructive sleep apnea (OSA) is often seen among obese individuals and the obesity has a linear association with MAFLD. The contribution of chronic intermittent nocturnal hypoxia of OSA and association of MAFLD with OSA is an unmet need. The present study aimed to determine the etiology, impact and association of OSA severity and nocturnal hypoxemia among patients ofChronic liver disease (CLD). Methods: In this study, analysis of the medical records and clinical details of the patients of CLD who had undergone polysomnography were analyzed after appropriate inclusion in study as per inclusion and exclusion criteria. After assessing the eligibility criteria, a total of 78 patients were included in the final analysis. Nocturnal hypoxemia was gauged from the baseline oxygen saturation record of study. Presence and severity of OSA were graded as per American Academy of Sleep Medicine (AASM) criteria. The primary objective of the study was to determine the association between OSA severity and nocturnal hypoxemia to the presence of Non-alcoholic Fatty Liver Disease (NAFLD). Secondary objectives were to assess the association of OSA severity and extent of nocturnal hypoxemia to the BMI and to determine the proportions of NAFLD subjects with OSA. Results: A total of 78 patients were screened, of which only 11 (14.1%) were female. Out of these, 56 (71.8%) were classified to MAFLD group while 22 (28.2%) were to the non-MAFLD group. The patients in MAFLD group with mean age of 56.02 years were older as compared to non-MAFLD with mean age of 51.05 years but that was not statistically different. Patients were categorized into MAFLD ( n = 56) and non-MAFLD, representing other etiologies of CLD ( n = 22; ethanol, chronic Hepatitis B virus (HBV), chronic Hepatitis C virus (HCV), cryptogenic, Non-cirrhosis portal fibrosis (NCPF), Primary sclerosing cholangitis (PSC), Autoimmune hepatitis (AIH), sarcoidosis, Wilson's disease). The mean BMI was significantly higher in MAFLD in comparison to non-MAFLD (34.51 ± 8.79 vs. 25.47 ± 5.75; P = 0.000) and also the median AHI of MAFLD group was significantly higher than the non-MAFLD 4.95 {(1.85, 25.47) vs. 0.85 (0.30, 2.72) ( P value < 0.000)} [Table 1]. Among the desaturation indices, the number of desaturations >3% {median of 122.50 (75.00, 241.25) vs. 63.00 (13.75, 158.00), P value 0.009} and average desaturation {mean of (5.04 ± 2.16) vs. (3.78 ± 1.226)%, P value 0.002} were significantly higher in MAFLD versus non-MAFLD group [Table 2]. The AHI and all desaturation parameters, although not statistically significant, were worst in Child B [Table 3]. Conclusion: MAFLD patients have higher prevalence and greater severity of OSA and worse nocturnal desaturation parameters as compared to non-MAFLD patients. OSA is in...

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association of Obstructive Sleep Apnea with Nocturnal Hypoxemia in Metabolic-Associated Fatty Liver Disease Patients

Tomar

Bhardwaj

Choudhary

et al. 2021

Journal of Family Medicine and Primary Care

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“…Of the several sleep disorders, obstructive sleep apnoea and short sleep duration have been established as risk factors for NAFLD. [6][7][8][9][10][11] On the other hand, only a few reports of the association between sleep quality and NAFLD have been published. 9 12 13 The Pittsburgh Sleep Quality Index (PSQI) is an established and widely used method for sleep quality evaluation; it comprises seven elements, including subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, sleep medication use and daytime dysfunction.…”

Section: Introductionmentioning

confidence: 99%

Effects of sleep quality on non-alcoholic fatty liver disease: a cross-sectional survey

Takahashi

Anzai²,

Kuroda

et al. 2020

BMJ Open

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BackgroundThe effects of sleep quality on the risk of developing non-alcoholic fatty liver disease (NAFLD) remain uncertain. The purpose of this study was to clarify the association between sleep quality and NAFLD.MethodsThe data of 4828 participants who underwent health check-ups at four hospitals were analysed. Sleep quality was evaluated by the Pittsburgh Sleep Quality Index (PSQI), which comprised seven elements scored from 0 to 3. The global PSQI score and the score for each element were compared between NAFLD and non-NAFLD groups separately by sex. Logistic regression analysis was performed to determine the association between NAFLD and each PSQI score.ResultsIn both men and women, the mean PSQI score for sleep medication use was significantly higher in non-NAFLD than in NAFLD. With regard to sleep medication use in men, the OR (95% CI) for NAFLD was lower with a score of 3 (OR 0.60, 95% CI 0.38–0.95) than with a score of 0 on multivariate logistic regression analysis adjusted for age, smoking habits and physical activity. The OR for NAFLD based on daytime dysfunction was also higher with a score of 3 than with a score of 0 in both men (OR 2.82, 95% CI 1.39–5.75) and women (OR 2.08, 95% CI 1.10–3.92). After adjustment for body mass index, the sleep latency scores in men and daytime dysfunction in women were associated with NAFLD.ConclusionSleep quality was associated with NAFLD, and there were sex differences.

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“…OSA has been shown to be correlated with the presence of NAFLD and severity of NAFLD, including lobular inflammation, ballooning degeneration, and fibrosis [ 118 - 120 ]. A recent study demonstrated an increased prevalence of NAFLD in patients with OSA, even in the absence of obesity or metabolic syndrome [ 120 ]. The data on the association between OSA and fibrosis are mixed.…”

Section: Obstructive Sleep Apnea (Osa)mentioning

confidence: 99%

Evaluation and management of extrahepatic manifestations of nonalcoholic fatty liver disease

et al. 2021

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Nonalcoholic fatty liver disease (NAFLD) is a multisystemic disease and a rapidly growing cause of chronic liver disease in children and adults worldwide. Diagnosis and management of extrahepatic manifestations of NAFLD, including cardiovascular disease (CVD), type 2 diabetes mellitus, metabolic syndrome, chronic kidney disease, obstructive sleep apnea, polycystic ovarian syndrome, hypothyroidism, psoriasis, and extrahepatic malignancy are crucial for the treatment of patients with NAFLD. The leading cause of death in NAFLD is primarily from CVD, followed by liver-related mortality, extrahepatic cancer, liver cancer, and diabetes-related mortality. Therefore, clinicians need to identify high-risk patients earlier in the disease course and be aware of the extrahepatic manifestations of NAFLD to improve liver disease outcomes. In this review, we focus on the monitoring and management of the extrahepatic manifestations of NAFLD.

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Association between non-alcoholic fatty liver disease and obstructive sleep apnea

Abstract: Author contributions: Umbro I wrote the paper; Umbro I and Fabiani V collected and analyzed data; Umbro I, Fabiani V, Fabiani M, Angelico F and Del Ben M designed the study, critically reviewed and approved the final version.

Cited by 42 publications

References 52 publications

Association of Obstructive Sleep Apnea with Nocturnal Hypoxemia in Metabolic-Associated Fatty Liver Disease Patients

Association of Obstructive Sleep Apnea with Nocturnal Hypoxemia in Metabolic-Associated Fatty Liver Disease Patients

Effects of sleep quality on non-alcoholic fatty liver disease: a cross-sectional survey

Evaluation and management of extrahepatic manifestations of nonalcoholic fatty liver disease

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